Blood Proteins and Imaging Tests May Predict the Risk of Cardiac Sarcoidosis

Risk factors: high BNP levels, myocardial inflammation and reduced left-ventricular function

A study found that an elevated blood level of B-type natriuretic peptide (BNP) is associated with a higher risk of death and serious cardiac complications in people with cardiac sarcoidosis.

The results also suggest that inflammation of the heart muscle (myocarditis) and reduced function of the left ventricle—the chamber that pumps oxygen-rich blood around the body—are associated with a poorer prognosis. These abnormalities can be measured with cardiac imaging.

The researchers described a clinically simple and useful triad of predictors for future events: serum BNP levels, the degree of left-ventricular dysfunction and the intensity of myocardial inflammation.

The study, “Outcome Predictors in a Contemporary Cardiac Sarcoidosis Population: The Role of Brain Natriuretic Peptide, Left-Ventricular Function and Myocardial Inflammation,” was published in the European Journal of Heart Failure.

Cardiac sarcoidosis occurs when granulomas affect the heart

Sarcoidosis is an inflammatory disorder in which clusters of immune cells called granulomas can form in different organs. Cardiac sarcoidosis (CS) means that the heart is involved.

The researchers reviewed data from 319 people with cardiac sarcoidosis treated at Royal Brompton Hospital in the United Kingdom between 2008 and 2018. About two thirds were men and the average age was in the mid-50s. Most (64.9%) had sarcoidosis affecting other parts of the body before CS was diagnosed, with a median disease duration of three years.

During follow-up, 26 people died and another 54 experienced serious cardiac events, including life-threatening problems requiring acute care or hospitalisation for heart failure. Statistical analyses were used to identify factors present at diagnosis that predicted these outcomes.

Elevated serum BNP was associated with more than twice the risk of death or another serious cardiac event, even after other factors were taken into account. Poor left-ventricular function measured by cardiac MRI and more intense myocardial inflammation were also associated with worse outcomes.

These findings may help clinicians identify people who need closer follow-up and earlier treatment. They do not replace an individual assessment by a cardiologist, and larger studies are needed to confirm the results.