{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:21:01Z","timestamp":1788351661582,"version":"build-2803163510"},"reference-count":29,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"unspecified","delay-in-days":54,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003793","name":"Swedish Heart-Lung Foundation","doi-asserted-by":"crossref","award":["20220140"],"award-info":[{"award-number":["20220140"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003793","name":"Swedish Heart-Lung Foundation","doi-asserted-by":"crossref","award":["20220194"],"award-info":[{"award-number":["20220194"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Stockholm County Council","award":["1001474"],"award-info":[{"award-number":["1001474"]}]},{"name":"Stockholm County Council","award":["998890"],"award-info":[{"award-number":["998890"]}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"crossref","award":["2022-00870"],"award-info":[{"award-number":["2022-00870"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,2,9]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Worse prognosis in cardiac sarcoidosis (CS) is likely associated with diagnostic delay and cardiac involvement as first sarcoidosis (de novo) presentation, but data are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively investigated 95 patients with CS diagnosed 2003\u20132024. Using electronic health records, the date of first CS symptoms\/signs, immunosuppressant therapy and follow-up data including left ventricular ejection fraction (LVEF), biomarkers and cardiac device therapy were extracted. Median time from first symptoms\/signs to CS diagnosis (9 months) was used to define delayed diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Implantation of cardiac resynchronisation therapy defibrillator was more likely in patients with diagnostic delay (p=0.01). No difference was observed in time to diagnosis between patients with de novo CS (n=49) and those with prior extracardiac sarcoidosis (ECS) (n=46). Severe symptoms at disease onset were more common in de novo CS. At a median of 46\u2009months from diagnosis, de novo patients more often had reduced LVEF (p=0.006) and an implantable cardioverter defibrillator (p&lt;0.05) than those with prior ECS despite receiving more immunosuppressant therapy. De novo patients with diagnostic delay more often had reduced LVEF at CS presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Symptom presentation is likely associated with diagnostic delay, but the disease presentation and course seem more severe in de novo CS and may not be altered by immunosuppressants, or demand more aggressive therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003934","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T15:50:14Z","timestamp":1771948214000},"page":"e003934","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic delay and phenotypic differences in cardiac sarcoidosis: a descriptive study of diagnostic and follow-up clinical data"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2844-4773","authenticated-orcid":false,"given":"Susanna","family":"Kullberg","sequence":"first","affiliation":[{"name":"Division of Immunology and Respiratory Medicine, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden"},{"name":"Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Fax\u00e9n","sequence":"additional","affiliation":[{"name":"Unit of Cardiology, Theme Cardiovascular and Neurology, Karolinska University Hospital, Stockholm, Sweden"},{"name":"Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Cagan","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasti","family":"Torabzadeh","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Eklund","sequence":"additional","affiliation":[{"name":"Division of Immunology and Respiratory Medicine, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden"},{"name":"Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Smed-S\u00f6rensen","sequence":"additional","affiliation":[{"name":"Division of Immunology and Respiratory Medicine, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pernilla","family":"Darlington","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, S\u00f6dersjukhuset, Stockholm, Sweden"},{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset and Karolinska Institutet, S\u00f6dersjukhuset and Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Eldhagen","sequence":"additional","affiliation":[{"name":"Unit of Cardiology, Theme Cardiovascular and Neurology, Karolinska University Hospital, Stockholm, Sweden"},{"name":"Unit of Cardiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marios","family":"Rossides","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden"},{"name":"Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"2026090204551101000_13.1.e003934.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2101555"},{"key":"2026090204551101000_13.1.e003934.2","doi-asserted-by":"crossref","DOI":"10.31083\/j.rcm2502037","article-title":"Cardiac Sarcoidosis: A Comprehensive Clinical Review","volume":"25","author":"Vereckei","year":"2024","journal-title":"Rev Cardiovasc 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Extra-cardiac and cardiac findings on clinical examination and whole-body 18F\u2013fluorodeoxyglucose positron emission tomography","volume":"253","author":"Juneau","year":"2018","journal-title":"Int J Cardiol"},{"key":"2026090204551101000_13.1.e003934.8","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.011522"},{"key":"2026090204551101000_13.1.e003934.9","doi-asserted-by":"crossref","first-page":"106864","DOI":"10.1016\/j.rmed.2022.106864","article-title":"Cardiac sarcoidosis outcome differences: A comparison of patients with de novo cardiac versus known extracardiac sarcoidosis at presentation","volume":"198","author":"Rosen","year":"2022","journal-title":"Respir Med"},{"key":"2026090204551101000_13.1.e003934.10","doi-asserted-by":"crossref","first-page":"132368","DOI":"10.1016\/j.ijcard.2024.132368","article-title":"Impact of extracardiac sarcoidosis on clinical outcomes in patients with cardiac sarcoidosis: Importance of continued screening for cardiac involvement","volume":"413","author":"Takaya","year":"2024","journal-title":"Int J Cardiol"},{"key":"2026090204551101000_13.1.e003934.11","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(77)90121-8"},{"key":"2026090204551101000_13.1.e003934.12","doi-asserted-by":"crossref","first-page":"102577","DOI":"10.1016\/j.cpcardiol.2024.102577","article-title":"Comparing outcomes of an \u2018early\u2019 versus \u2018late\u2019 diagnosis of cardiac sarcoidosis following a baseline presentation of high-grade atrioventricular block","volume":"49","author":"Ahmed","year":"2024","journal-title":"Curr Probl Cardiol"},{"key":"2026090204551101000_13.1.e003934.13","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euaa115"},{"key":"2026090204551101000_13.1.e003934.14","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1536\/ihj.17-492","article-title":"Importance of Early Diagnosis of Cardiac Sarcoidosis in Patients with Complete Atrioventricular Block","volume":"59","author":"Kaida","year":"2018","journal-title":"Int Heart J"},{"key":"2026090204551101000_13.1.e003934.15","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.122.028342","article-title":"Long-Term Outcomes of Cardiac Sarcoid: Prognostic Implications of Isolated Cardiac Involvement and Impact of Diagnostic Delays","volume":"12","author":"Sink","year":"2023","journal-title":"J Am Heart Assoc"},{"key":"2026090204551101000_13.1.e003934.16","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCEP.117.006145","article-title":"Outcome of Cardiac Sarcoidosis Presenting With High-Grade Atrioventricular Block","volume":"11","author":"Nordenswan","year":"2018","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2026090204551101000_13.1.e003934.17","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/HCO.0000000000001200","article-title":"Cardiac sarcoidosis; 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Prognostic value of the clinical phenotype in patients with cardiac sarcoidosis: SARCO phenotype. J Cardiol 2025. doi:10.1016\/j.jjcc.2025.10.009","DOI":"10.1016\/j.jjcc.2025.10.009"},{"key":"2026090204551101000_13.1.e003934.29","article-title":"Characteristics and incidence of cardiac events across spectrum of age in cardiac sarcoidosis","volume":"50","author":"Nabeta","year":"2024","journal-title":"Int J Cardiol Heart Vasc"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2025-003934","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:55:25Z","timestamp":1788350125000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2025-003934"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2,24]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/openhrt-2025-003934"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2025-003934","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}