Comparison of Clinical and Morphologic Findings in Patients With Cardiac Sarcoidosis Severe Enough to Warrant Heart Transplantation in Those With -vs- Those Without Non-Caseating Granulomas in the Explanted Heart (Burnt-Out Sarcoid)

Can cardiac sarcoidosis with heart failure severe enough to warrant orthotopic heart transplantation (OHT) be present without non-caseating granulomas in the explanted heart? The objective is to compare clinical and morphological features in patients with cardiac sarcoidosis severe enough to warrant OHT with -vs-without non-caseating granulomas in the explanted heart. The study was conducted at Baylor University Medical Center in Dallas, Texas. From a total of 671 explanted hearts examined from 1993 to 2018, twenty-five (4%) had gross morphologic features characteristic of cardiac sarcoidosis. At the time of OHT, the patients ranged in age from 50 to 69 years [mean 57]. Cardiac sarcoidosis was diagnosed before OHT in 3 (12%) patients, by percutaneous biopsy of the heart in 2 patients and by histologic examination of the "left ventricular core" in 1 patient who had a left ventricular assist device inserted, and, by examination of the native heart after OHT in the remaining 22 (88 %) patients. Of the 25 patients, 16 (64%) had typical sarcoid non-caseating granulomas in the explanted heart, and 9 (36%) had no granulomas in the explanted heart. Comparison of certain clinical and morphologic features in the group with -vs- the group without cardiac granulomas showed no significant differences. In conclusion, of patients with cardiac sarcoidosis severe enough to warrant OHT, some have typical non-caseating granulomas in the explanted heart and some do not. The clinical and gross morphologic features of those with and those without cardiac granulomas are similar. (C) 2019 Elsevier Inc. All rights reserved.