Sarcoidosis is a granulomatous inflammatory illness that affects the entire body. Cardiac involvement is linked to an increase in morbidity. However, clinical features and prognosis changes based on early sarcoidosis organ presentation have not been observed in individuals with cardiac sarcoidosis (CS).

A cohort of 252 individuals with CS from an urban quaternary medical institution was investigated retrospectively. De novo CS and previous ECS groups were compared in terms of presentation, treatment, and results. In addition, survival without the primary composite endpoint (installation of a left ventricular assist device, orthotopic heart transplantation (OHT), or death) was evaluated.

At the time of CS diagnosis, there were 124 de novo CS patients and 128 with previous ECS. Patients diagnosed with CS for the first time were younger (P=0.020). De novo CS patients had a more advanced cardiac presentation: lower left ventricular ejection fraction (LVEF) (P<0.001), more persistent ventricular arrhythmias (VA) (P=0.001), and total heart block (P=0.001). During follow-up, the de novo CS group had a higher rate of new VA (P<0.001), ventricular tachycardia ablation (P<0.001), and OHT (P=0.003). When compared to ECS patients, de novo CS patients had substantially shorter outcome-free survival (P=0.005), with an elevated risk of primary composite outcome (P=0.034) and development of new VA (P=0.027). Overall mortality was comparable among groups.

Patients who reported CS as their first identified organ manifestation of sarcoidosis had a higher risk of severe cardiac outcomes than those with an ECS history. Improved CS awareness and diagnosis are required for earlier detection.