Topic
Procedure
N (% endorsing)
Indications for initiation of immunomodulatory therapy
(a) Hypermetabolic activity on a cardiac FDG–PET scan
24 (77.4 %)
(b) Delayed enhancement on cardiac MRI
19 (61.3 %)
(c) Conduction defects
21 (67.7 %)
(d) LV dysfunction
24 (77.4 %)
(e) RV dysfunction in the absence of pulmonary hypertension
18 (58.1 %)
(f) Ventricular arrhythmias
24 (77.4 %)
(g) Atrial arrhythmias
13 (41.9 %)
(h) Other
7 (22.6 %)
Immunosuppressive therapies used in treating cardiac sarcoidosis
(a) Prednisone
30 (96.8 %)
(b) Methotrexate
12 (38.7 %)
(c) Azathioprine
6 (19.4 %)
(d) Mycophenolate mofetil
2 (6.5 %)
(e) Anti-TNF agent
5 (16.1 %)
(f) Other
5 (16.1 %)
Dose of prednisone used
(a) 20 mg
4 (12.9 %)
(b) 30–40 mg
14 (45.2 %)
(c) 60 mg
7 (22.6 %)
(d) 0.5 mg/kg/ideal body weight
3 (9.7 %)
(e) 1 mg/kg/ideal body weight
2 (6.5 %)
(f) I don’t use prednisone
0 (0 %)
(g) Other
2 (6.5 %)
Initiation of steroid sparing agent with corticosteroids
(a) No
11 (42.3 %)
(b) Yes
12 (46.2 %)
(c) Other
4 (15.4 %)
Does the initial dosage of steroids differ depending on indication (active arrhythmias versus cardiomyopathy)?
(a) No, I use the same dosing range no matter what the indication
19 (70.4 %)
(b) Yes, I choose a higher dose for arrhythmias
6 (22.2 %)
(c) Yes, I choose a higher dose for cardiomyopathy
3 (11.1 %)
(d) Other
2 (7.4 %)
Duration of immunosuppressive therapy
(a) 1 year
4 (14.8 %)
(b) 2 years
5 (18.5 %)
(c) Indefinitely
7 (25.9 %)
(d) Other
13 (48.1 %)
Does the duration of immunosuppressive therapy differ depending on indication (active arrhythmias versus cardiomyopathy)?
(a) No
18 (66.7 %)
(b) Yes
6 (22.2 %)
(c) Other
7 (25.9 %)
Table 11.2
Agents commonly used in the management of sarcoidosis. None of the steroid-sparing agents have been studied in cardiac sarcoidosis
Recommended dose | Main side-effects | Monitoring needed | Comments | |
|---|---|---|---|---|
Prednisone | 20–30 mg daily or equivalent to be tapered gradually over 6 months | Weight gain, increase blood sugar, hypertension, osteopenia/osteoporosis, infection, neuropsychiatric reactions, infections | Blood sugar, weight, blood pressure, bone density | Rapid-acting but has numerous short and long term side effects |
Methotrexate [18] < div class='tao-gold-member'>
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