Effect of Corticosteroid Dose and Duration on Left Ventricular Ejection Fraction in Cardiac Sarcoidosis

Background Corticosteroids are the therapeutic mainstay in cardiac sarcoidosis (CS). However, optimal dose and duration of therapy and predictors of patient response are not known. We aimed to describe the change in left ventricular ejection fraction (LVEF) and impact of prednisone regimen on LVEF in patients with CS. Methods Patients with CS treated with prednisone underwent echocardiographic assessment of LVEF prior to (EFpre) and at approximately 1 year after therapy initiation (EFpost). Details about prednisone regimen (initial burst dose [BD] and duration of burst therapy [DT]) were collected from the medical record. We calculated 1-year change in LVEF (EFpost - EFpre = Δ EF1 yr). We compared patients with 10% or greater LVEF increase to those without (Δ EFINC ≥ 10% vs Δ EFINC Results Of 29 patients (31% female, 38% African American, age 53±11 years), 11 (38%) had Δ EFINC ≥ 10% and 6 (21%) had Δ EFDEC ≥ 10% (Figure A). Compared with patients with Δ EFINC 60 days (20% vs 43%; p=0.06). There was no difference in the use of heart failure medications or steroid sparing agents between these groups. Compared to patients with Δ EFDEC 60 days (48% vs 67%, p=0.65). Among patients with EFpre Conclusions Patients with CS who had a clinically meaningful improvement in LVEF after prednisone therapy had lower pretreatment LVEF, higher burst prednisone dose, and a shorter burst dose duration. Patients with CS who had a clinically meaningful decrease in LVEF had higher pretreatment LVEF. A larger prospective study is needed to better understand optimal immunosuppressive strategies in CS and effect on LVEF.