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Abstract
Background Patients with cardiac sarcoidosis (CS) can present with atrioventricular conduction defects and heart failure (HF) with reduced ejection fraction (EF). Cardiac resynchronization therapy (CRT) may improve ejection fraction, reduce mortality and HF-related hospitalization in CS patients, however the clinical evidence supporting its efficacy is very limited.
Purpose The aim of this study is to systematically synthesize the available data and provide the most comprehensive evidence regarding the effectiveness of CRT in patients with CS. This is the first proportional meta-analysis to assess the usefulness of CRT in CS and address the existing literature gap.
Methods A systematic literature search was conducted using PubMed/Medline, Embase, and the Cochrane library from inception to February 2024. The aim of this search was to identify studies that reported clinical outcomes following the use of CRT in CS patients. Data for outcomes was extracted, pooled, and analyzed. We used OpenMetaAnalyst for pooling untransformed proportions using DerSimonian Laird random effects model.
Results Five studies with a total of 176 CS patients who received CRT were included. The pooled incidence for all-cause mortality was 7.6% (95% CI: -0.03 to 0.18), for HF-related hospitalizations 23.2% (95% CI: 0.02 to 0.43), and for major adverse cerebral and cardiovascular events 27% (95% CI: 0.08 to 0.45) on a mean follow-up of 21.6 months in patients who received CRT. The pooled left ventricular ejection fraction (LVEF) was 34.28% (95% CI: 29.88 to 38.68) showing an improvement of 3.75% in LVEF from baseline. The average New York Heart Association (NYHA) functional class was 2.16 (95% CI: 1.47 to 2.84) after CRT as compared to baseline average NYHA of 2.58.
Conclusion CRT leads to variable response in patients with CS. Although improvements were observed in LVEF and average NYHA, further evidence is required to establish the effectiveness of CRT.
A: Forest Plot of all-cause mortality in studies containing cardiac sarcoidosis patients with cardiac resynchronization therapy. B: Forest Plot of heart failure related hospitalizations in studies containing cardiac sarcoidosis patients with cardiac resynchronization therapy. C: Forest Plot for major adverse cerebral and cardiovascular events in studies containing cardiac sarcoidosis patients with cardiac resynchronization therapy. D: Forest Plot for left ventricular ejection fractions in studies containing cardiac sarcoidosis patients with cardiac resynchronization therapy. E: Forest Plot for NYHA class in studies containing cardiac sarcoidosis patients with cardiac resynchronization therapy
Conflict of Interest none