{
  "abstract": "Introduction Cardiac sarcoidosis (CS) is an underdiagnosed but significant cause of cardiac morbidity that can present variably; commonly with conduction abnormalities, ventricular arrhythmias and heart failure. It is estimated to be clinically evident in 5% of patients with sarcoidosis, with sub-clinical incidence reported to be up to 20–25%.Methods A retrospective analysis was undertaken of case notes of patients with sarcoidosis (n=171) under the care of the Sarcoid Team at Manchester Royal Infirmary, UK. Persons identified to have cardiac involvement were further analysed including patient demographics, baseline biochemical investigations, advanced cardiac imaging techniques, cardiac complications and subsequent management including both immunosuppression and cardiac implantable electronic devices (CIED).Results The cohort included 9 patients; 2 female and 7 male with a mean age of CS diagnosis at 59.4 years ( table 1). Prevalence of cardiac involvement was 5.3%, in keeping with reported figures. There was an average interval of 3.7 years from extra-cardiac sarcoidosis diagnosis to CS diagnosis. Ventricular arrhythmias (n=3) and conduction abnormalities (n=3) were the most common cardiac feature, with patients also presenting with heart failure (n=1), pericardial effusion (n=1) and incidental detection on imaging (n=1). Mean angiotensin-converting enzyme (ACE) level at diagnosis was 51.4 IU/L, reducing to 37.8 IU/L 2 years after CS diagnosis. Mean CRP at diagnosis was mildly raised at 11.7 mg/L, whereas ESR was within normal limits (7.8 mm/hr). Mean left ventricular ejection fraction at initial presentation was 52% (table 2). Cardiac MRI was undertaken in 78% of patients with 5 illustrating evidence of late gadolinium enhancement and 5 illustrating myocardial oedema. The most involved anatomical cardiac regions were the inferior left ventricle (LV) (n=4) and septal LV (n=3). 6 patients underwent CIED implantation, of which 4 were upgraded to include an ICD with 1 further patient presently awaiting this. Prednisolone induction was used in 8 patients; 3 patients were successfully weaned off prednisolone (mean course length of 16.3 months) and methotrexate was subsequently used in 5 cases.Abstract 1-008 Table 1Baseline characteristics of patients with cardiac sarcoidosis (CS) under the sarcoid team at manchester royal infirmary (n=9) Gender, n Female: 2Male: 7 Ethnicity, n BAME: n=4 (44%)Non-BAME: n=5 (56%) Age at sarcoid diagnosis, mean (years) 55.8 Age at CS diagnosis, mean (years) 59.4 Interval between diagnosis of sarcoid and CS, mean (years) 3.7 Presenting cardiac issue, n Ventricular arrhythmia: 3Heart failure: 1Conduction abnormality: 3Pericardial effusion: 1Incidental detection: 1 Biochemical markers at diagnosis, mean Lymphocytes: 1.3 x109/LCRP: 11.7 mg/LESR 7.8 mm/HrACE: 51.4 IU/L ACE (2 years post diagnosis): 37.8 IU/L Hs-cTnT: 32.7 ng/LTotal 25-Hydroxy Vitamin D: 50.6 nmol/LAdjusted calcium: 2.4 mmol/LBAME = Black, Asian, and Minority Ethnic, CS = cardiac sarcoidosis, ACE = Angiotensin converting enzyme, CRP = C-reactive protein, ESR = Erythrocyte sedimentation rate, Hs-cTnT = High-sensitivity cardiac troponin-t.Abstract 1-008 Table 2Investigations and management of patients with cardiac sarcoidosis (CS) under the sarcoid team at manchester royal infirmary (n=9) LVEF at presentation, mean 52% Cardiac MRI undertaken and relevant features, n 7 Late gadolinium enhancement: 5 Myocardial oedema: 5 Ventricular wall involvement on cardiac MRI, n Transmural:1Subepicardial: 5Sub-endocardial: 2Mid-wall: 3 Anatomical regions of involvement on cardiac MRI, n Inferior LV: 4Septal LV: 3Septal RV: 2Anterior LV: 2Inferolateral LV: 2Lateral LV: 1 FDG Cardiac PET-CT undertaken, n 6 Adequate suppression of inflammation on subsequent FDG Cardiac PET-CT, n Yes: 2No: 1 Histological confirmation of extra-cardiac sarcoidosis , n 7 Immunosuppressives used, n Prednisolone: 8 (3 patients successfully weaned, mean course length 16.3 months) Methotrexate: 5 Use of CIED (n=6) CRT-D: 4Dual chamber pacemaker with ICD: 2 (1 of which is awaiting upgrade to ICD)LVEF = Left ventricular ejection fraction, MRI = Magnetic resonance imaging, LV = Left ventricular, FDG Cardiac PET-CT = Fluorodeoxyglucose cardiac positron emission tomography-computed tomography, CIED = cardiac implantable electronic device, CRT = Cardiac resynchronisation therapy defibrillator, ICD = Implantable cardioverter defibrillator.Conclusions The data illustrates the diverse nature and presentation of cardiac sarcoidosis and management strategies within a district general hospital. Vigilance is required to detect cases as there are preventable life-threatening consequences of the disease. In particular it was evident that patients with indications for a CIED were appropriately considered for upgrade to ICD according to current published evidence. It is likely that cases of CS are under-recognised and as advanced cardiac imaging techniques become more widely available there will be increasing incidence. Locally a monthly virtual MDT meeting is being developed to discuss cases of extra-thoracic sarcoidosis.",
  "authors": [
    {
      "affiliations": [
        "Department of Respiratory Medicine, Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, UK"
      ],
      "name": "Callum Blunt"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, UK"
      ],
      "name": "Seema Brij"
    }
  ],
  "title": "1-008 A retrospective case series analysis of cardiac sarcoidosis patients at a district general hospital",
  "uid": "6be3cc8d-0a9b-571b-bf04-4d8a6132b791"
}