Abstract 14804: Time-Course and Influencing Factors of Ventricular Tachy-Arrhythmias After Initiation of Steroid Therapy in Patients With Cardiac Sarcoidosis

Introduction: It is widely known that ventricular tachy-arrhythmias (VTs) are often observed in patients with cardiac sarcoidosis (CS) as one of the presentations of poor prognosis. However, the time-course and influencing factors of VTs after the introduction of corticosteroid therapy in CS patients remain to be elucidated. Methods and Results: We examined the influence of steroid therapy on VTs in 68 consecutive CS patients in Tohoku University Hospital from October 1998 until September 2014 (57±11 years-old, M/F 18/50). CS was diagnosed based on the original guidelines for diagnosis of CS from the Japanese Ministry of Health and Welfare. Corticosteroid therapy was performed in all CS patients. VTs were defined as sustained ventricular tachycardia/fibrillation or appropriate ICD therapy events. During a mean follow-up of 5.5 years, 20 out of 68 patients (29%) experienced VTs after the initiation of corticosteroid therapy, and 14 (70%) of them had VTs in the first 12 months (Figure A). Multivariable analysis showed that the positive gallium scintigraphy was an independent risk factor for VTs (odds ratio, 17.4; 95% CI, 1.03-294, P=0.047). Survival free from VTs events was significantly lower in the Ga-positive group than in the Ga-negative group (P<0.001), where most of the events were developed in the early phase in the Ga-positive group (Figure B). Furthermore, electrical storm (ES) of VTs was noted in 10 patients (14.7%), and most of them (8 out of the 10 patients) had ES in the first 12 months, whereas the recurrence of ES was relatively low (Figure C). Conclusions: VTs or ES in CS patients was frequently noted in the first 12 months after initiation of corticosteroid therapy, possibly representing inflammatory conditions, for which Ga scintigraphy is useful diagnostic strategy and Ga-positive is an independent prognostic factor in CS.

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Time Course and Factors Correlating With Ventricular Tachyarrhythmias After Introduction of Steroid Therapy in Cardiac Sarcoidosis

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.115.003353 ◽

2016 ◽

Vol 9 (6) ◽

Cited By ~ 24

Author(s):

Masato Segawa ◽

Koji Fukuda ◽

Makoto Nakano ◽

Masateru Kondo ◽

Hiroyuki Satake ◽

...

Keyword(s):

Steroid Therapy ◽

Time Course ◽

Cardiac Sarcoidosis ◽

Ventricular Tachyarrhythmias

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Effect of Corticosteroid Therapy in Patients with Cardiac Sarcoidosis on Frequency of Venous Thromboembolism

The American Journal of Cardiology ◽

10.1016/j.amjcard.2021.03.017 ◽

2021 ◽

Author(s):

Nikhil Kolluri ◽

Mohamed Y. Elwazir ◽

Andrew N. Rosenbaum ◽

Fathi A. Maklady ◽

Omar F. AbouEzzeddine ◽

...

Keyword(s):

Venous Thromboembolism ◽

Corticosteroid Therapy ◽

Cardiac Sarcoidosis

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Serial computed tomography findings of Coronavirus disease 2019 (COVID-19) pneumonia treated with favipiravir and steroid therapy: report of 11 cases

Bulletin of the National Research Centre ◽

10.1186/s42269-021-00553-7 ◽

2021 ◽

Vol 45 (1) ◽

Author(s):

Naoki Irizato ◽

Hiroshi Matsuura ◽

Atsuya Okada ◽

Ken Ueda ◽

Hitoshi Yamamura

Keyword(s):

Computed Tomography ◽

Mechanical Ventilation ◽

Steroid Therapy ◽

Time Course ◽

Ground Glass ◽

Time Points ◽

Ct Findings ◽

Mixed Pattern ◽

Bronchial Dilatation

Abstract Background This study evaluated the time course of computed tomography (CT) findings of patients with COVID-19 pneumonia who required mechanical ventilation and were treated with favipiravir and steroid therapy. Results Eleven patients with severe COVID-19 pneumonia were included. CT findings assessed at the three time points showed that all patients had ground-glass opacities (GGO) and consolidation and mixed pattern at intubation. Consolidation and mixed pattern disappeared in most of the patients whereas GGO persisted in all patients at 1-month follow-up. In addition to GGO, a subpleural line and bronchus distortion and bronchial dilatation were frequent findings. The degree of resolution of GGO varied depending on each patient. The GGO score correlated significantly with the time from symptoms onset to initiation of steroid therapy (ρ = 0.707, p = 0.015). Conclusions At 1-month follow-up after discharge, non-GGO lesions were absorbed almost completely, and GGO were a predominant CT manifestation. Starting steroid therapy earlier after onset of symptoms in severe COVID-19 pneumonia may reduce the extent of GGO at 1-month follow-up.

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1171. Lower Mortality with Adjuvant Corticosteroid Therapy in non-HIV Infected Patients with pneumocystis jirovecii pneumonia: A Single US Cohort Study and a Proposed Novel Mechanism of Corticosteroids

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1357 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S610-S611

Author(s):

William Mundo ◽

Carlos Franco-Paredes ◽

Steven C Johnson ◽

Leland Shapiro ◽

Andres Henao-Martinez

Keyword(s):

Corticosteroid Therapy ◽

Multivariable Analysis ◽

Solid Organ Transplantation ◽

Pneumocystis Jirovecii ◽

Lower Mortality ◽

Pneumocystis Jirovecii Pneumonia ◽

Solid Organ ◽

Hiv Status ◽

Predictors Of Mortality ◽

Hiv Negative

Abstract Background Pneumocystis jirovecii pneumonia (PJP) remains a cause of mortality in HIV-negative patients. The clinical benefit of adjuvant corticosteroids given at the time of PJP antimicrobial therapy in these patients is uncertain. This study aimed to determine if corticosteroids reduced mortality in a cohort of HIV-negative PJP patients, and to propose a novel mechanism explaining corticosteroid benefit in patients regardless of HIV status. Methods We examined a retrospective case series of patients diagnosed with PJP at the University of Colorado Hospital between 1995-2019. Data were collected in 71 PJP-infected patients. Twenty-eight patients were HIV-negative, and 43 were infected with HIV. We performed bivariate and forward, stepwise multivariable logistic regressions to identify predictors of mortality. Results Underlying conditions in HIV-negative patients were hematologic malignancies (28.6%), autoimmune disorders (25.9%), or solid organ transplantation (10.7%). Compared to HIV-positive patients, HIV-negative patients had higher rates and duration of mechanical ventilation and ICU stay. Survival was significantly increased in HIV-negative patients receiving adjunct corticosteroids, with 100% mortality in patients not receiving corticosteroids vs 60% mortality in patients receiving corticosteroids (p=0.034). In an adjusted multivariable model, corticosteroids were associated with lower mortality (OR 13.5, 95% CI: 1.1-158.5, p= 0.039) regardless of HIV status. In a novel model of adjunct corticosteroid benefit, we propose corticosteroids reduce immune-mediated lysis of Pneumocystis organisms that curtails the surfactant-disabling effect of PJP internal contents. Table 1. Multivariable Analysis of Predictors of Mortality in patients with PJP Figure 1. Mortality differences by HIV status and use of steroids in PJP Conclusion We found substantial mortality among HIV-negative patients with PJP and adjunct corticosteroid use was associated with decreased mortality. Adjunct corticosteroid mortality-lowering effect is best explained by suppressing pneumocystis lysis. This reduces surfactant disruption resulting from pneumocystis internal substances. Figure 2. Proposed mechanism of action for benefits of adjunct exogenous corticosteroid therapy during PJP Disclosures All Authors: No reported disclosures

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Clinical valuables related to resolution of complete or advanced atrioventricular block after steroid therapy in patients with cardiac sarcoidosis

Journal of Arrhythmia ◽

10.1002/joa3.12583 ◽

2021 ◽

Author(s):

Takeru Nabeta ◽

Masahiko Hara ◽

Takashi Naruke ◽

Kenji Maemura ◽

Takumi Oki ◽

...

Keyword(s):

Atrioventricular Block ◽

Steroid Therapy ◽

Cardiac Sarcoidosis

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Complete heart block in cardiac sarcoidosis reversed by corticosteroid therapy: time course of resolution

BMJ Case Reports ◽

10.1136/bcr-2020-240834 ◽

2021 ◽

Vol 14 (3) ◽

pp. e240834

Author(s):

Anna Tomdio ◽

Huzaefah Syed ◽

Kenneth Ellenbogen ◽

Jordana Kron

Keyword(s):

Heart Block ◽

Time Course ◽

Cardiac Sarcoidosis ◽

Complete Heart Block ◽

Positron Emission ◽

Av Conduction ◽

Magnetic Resonance Imaging Mri ◽

High Level ◽

Active Inflammation ◽

Lateral Walls

A 53-year-old man was admitted for recurrent syncope and found to have complete heart block (CHB). Cardiac magnetic resonance imaging MRI) showed extensive patchy late gadolinium enhancement in the apical and lateral walls, consistent with cardiac sarcoidosis (CS) but no scar in the septum. A fluorodeoxyglucose (FDG)–positron emission tomography showed FDG uptake in the septum and basal lateral walls. Imaging suggested active inflammation in the septum affecting atrioventricular (AV) conduction but no irreversible fibrosis. Diagnosis of isolated CS requires a high level of suspicion and multidisciplinary teamwork involving heart failure specialists, electrophysiologists and rheumatologists. After specialist and patient discussion, treatment of the disease was initiated with prednisone 40 mg daily, 11 months after presenting with CHB. Three weeks later, ECG with pacing inhibited showed second-degree AV block Mobitz type II and 4 weeks later, AV conduction recovery. This highlights the importance of immediate therapy in reversing AV conduction abnormalities in CS.

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Intravenous Methylprednisolone for Ventricular Tachycardia Electrical Storm in Cardiac Sarcoidosis

JACC: Clinical Electrophysiology ◽

10.1016/j.jacep.2020.12.003 ◽

2021 ◽

Vol 7 (4) ◽

pp. 536-537

Author(s):

Tahir S. Kafil ◽

Robert Sparrow ◽

Habib R. Khan ◽

Usha Manian ◽

Maged Elrayes ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Cardiac Sarcoidosis ◽

Electrical Storm ◽

Intravenous Methylprednisolone

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Cardiac Sarcoidosis: Cytokine Patterns in the Course of the Disease

Archives of Pathology & Laboratory Medicine ◽

10.5858/2003-127-1207-cscpit ◽

2003 ◽

Vol 127 (9) ◽

pp. 1207-1210 ◽

Cited By ~ 1

Author(s):

Michael Schoppet ◽

Sabine Pankuweit ◽

Bernhard Maisch

Keyword(s):

Time Course ◽

Mononuclear Cells ◽

Cardiac Sarcoidosis ◽

Systemic Disease ◽

Healing Process ◽

Unknown Etiology ◽

Enzyme Linked Immunosorbent Assay ◽

Rapid Decline ◽

Peripheral Blood Mononuclear ◽

Multiple Organs

Abstract Sarcoidosis is a chronic systemic disease of unknown etiology, which is characterized by noncaseating epitheloid granulomas usually in multiple organs. Here we describe changes in cytokine mRNA expression by peripheral blood mononuclear cells (PBMCs) and changes of cytokine protein levels in plasma over a time course of 12 months in a patient with sarcoidosis confined to the heart as diagnosed by endomyocardial biopsy. Mitogen-stimulated PBMCs exhibited a more TH1 cytokine profile at onset of symptoms before immunosuppressive therapy was initiated, with a change to a TH0 response in the course of the disease as evidenced by multiplex-polymerase chain reaction. In plasma, high levels of interleukin-6 could be detected by an enzyme-linked immunosorbent assay system, with rapid decline correlating with immunosuppression and improving clinical course. These changes may point to a role of TH1 and TH2 cytokines in the pathogenesis and the healing process of cardiac sarcoidosis.

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Analysis of Factors Affecting the High Subjective Well-Being of Chinese Residents Based on the 2014 China Family Panel Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16142566 ◽

2019 ◽

Vol 16 (14) ◽

pp. 2566 ◽

Cited By ~ 3

Author(s):

Wen Xu ◽

Haiyan Sun ◽

Bo Zhu ◽

Wei Bai ◽

Xiao Yu ◽

...

Keyword(s):

Physical Exercise ◽

Influencing Factors ◽

Low Income ◽

Social Trust ◽

Population Distribution ◽

Panel Study ◽

Multivariable Analysis ◽

Logistic Models ◽

Well Being ◽

Subjective Well Being

(1) Purpose: The purpose of our research is to understand the subjective well-being (SWB) of Chinese adult residents and its influencing factors and to identify the key groups and areas to provide a basis for the formulation of relevant policies to improve residents’ happiness. (2) Methods: In this study, we analyzed the influencing factors of SWB of individuals older than 16 years of age, according to the 2014 China Family Panel Study (CFPS). We weighted 27,706 samples in the database to achieve the purpose of representing the whole country. Finally, descriptive statistics were used for the population distribution, chi-square tests were used for univariable analysis, and binary logistic models were used for multivariable analysis. (3) Results: The response rate of SWB was 74.58%. Of the respondents, 71.2% had high SWB (7–10), with a U-shaped distribution between age and SWB. Females are more likely than males to rate themselves as happy. There is a positive ratio between years of education and SWB. Residents who have better self-evaluated income, self-rated health (SRH), psychological well-being (PWB), Body Mass Index (BMI), social trust, social relationships, and physical exercise have higher SWB. (4) Conclusion: The results of the present study indicate that to improve residents’ SWB, we should focus more attention on middle-aged and low-income groups, particularly men in agriculture. The promotion of SWB should be facilitated by improvements in residents’ education, health status, and social support as well as by the promotion of smoking bans and physical exercise.

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