Prognostic implications of interventricular septal wall thickness in cardiac sarcoidosis
K Takamura, Y Baba, T Kubo, Y Yoshikawa, K Kusano, T Kitai, T Tamura, Y Takaya, M Mori, H Tanaka, K Sato, S Ishii, K Nishimura, H Kitaoka, C IzumiAbstract
Background
Localized thinning or, in some cases, thickening of the interventricular septum has been recognized as a morphologic feature of cardiac sarcoidosis (CS). However, the prognostic significance of interventricular septal thickness (IVST) in patients with CS remains unclear.
Purpose
This study aimed to investigate the clinical implication of IVST in patients with CS.
Methods
This is a post-hoc analysis of a multicenter nationwide retrospective observational study, we analyzed patients diagnosed as CS and with available data for IVST measured at the time of diagnosis. Patients were stratified according to IVST into five groups at 2-mm intervals, centered on the median value of 9 mm, which also corresponds to the normal reference range: group 1 (≤ 6.0 mm), group 2 (6.1–8.0 mm), group 3 [reference] (8.1–10.0 mm), group 4 (10.1–12.0 mm), and group 5 (≥ 12.1 mm). The primary outcome was the composite outcome of all-cause death, fatal ventricular arrhythmia events, or heart failure hospitalization.
Results
In 1775 patients [64 (56-71) years old, 65.2% female], 454 primary outcomes were observed during the median follow-up period of 4.3 (2.4–6.5) years. The 5-year event rates of the primary outcome were 22.0%.Kaplan–Meier curves demonstrated higher incidences of primary outcome in IVST groups deviating from the reference group. The spline analysis indicated a J-curve–like association of IVST with the primary outcome. Although, in the univariable analysis, patients in group 1 and in the combined group 1 and 5 had a significant risk of the primary outcome than those in the other IVST groups (HR 1.46, 95%CI [1.12-1.89] and HR 1.38, 95%CI [1.11-1.71], respectively), no significant association with the primary outcome was observed for any of these groups in the multivariable analysis.
Conclusions
In patients with CS, there was no association with deviation of IVST and the risk of the composite of all-cause death, fatal ventricular arrhythmia events, or heart failure hospitalization after adjustment.Kaplan–Meier curves for the primary outcomeSpline analysis of IVST and hazard ratio