{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T00:14:09Z","timestamp":1772842449191,"version":"3.50.1"},"reference-count":18,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"unspecified","delay-in-days":64,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"JSPS KAKENHI","award":["19K08570"],"award-info":[{"award-number":["19K08570"]}]},{"name":"JSPS KAKENHI","award":["23FC1030"],"award-info":[{"award-number":["23FC1030"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,2,18]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Japanese guidelines recommend a corticosteroid maintenance dose of 5\u201310 mg\/day for cardiac sarcoidosis (CS); however, the optimal dose remains unclear. This study aimed to evaluate the impact of maintenance dose and corticosteroid re-escalation on prognosis in patients with CS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicentre retrospective cohort study used data from a Japanese nationwide CS registry. A total of 352 patients diagnosed according to the Japanese Circulation Society 2016 guideline and treated with oral corticosteroids were included. Patients were grouped by maintenance dose: low (&lt;5.0 mg\/day), recommended (5.0\u201310.0 mg\/day) and high (&gt;10.0 mg\/day). Clinical outcomes were analysed. The main outcome was all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The low-dose, recommended-dose and high-dose groups comprised 11% (n=40), 78% (n=276) and 10% (n=36) of patients, with mean maintenance doses of 2.2 mg\/day, 6.7 mg\/day and 16.2 mg\/day, respectively. During a median follow-up of 5.12 years, 39 patients (11%) died. Kaplan-Meier survival analysis showed statistically better survival in the recommended dose group, with the high-dose group showing statistically significantly worse outcomes (log-rank p=0.012). Corticosteroid re-escalation occurred in 19% of patients (9% before and 11% after achieving maintenance dose). All-cause mortality was 8% in the recommended-dose group versus 25% in the low-dose and 17% in the high-dose groups. In univariable analyses, re-escalation after achieving maintenance was associated with mortality in the high-dose group (HR 4.34, 95% CI 1.24 to 98.3), whereas re-escalation before achieving maintenance was associated with mortality in the low-dose group (HR 19.41, 95% CI 2.71 to 138.5).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A recommended maintenance dose of corticosteroids was associated with better prognosis in patients with CS. Achieving and maintaining this dose appears critically important in clinical management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004048","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T14:35:34Z","timestamp":1772807734000},"page":"e004048","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic impact of corticosteroid maintenance dose and re-escalation in patients with cardiac sarcoidosis"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8490-6699","authenticated-orcid":false,"given":"Takuya","family":"Nishimura","sequence":"first","affiliation":[{"name":"National Cerebral and Cardiovascular Center, Suita, Japan"},{"name":"Department of Cardiology and Geriatrics, Kochi Medical School Kochi University, Nankoku, Kochi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7890-9554","authenticated-orcid":false,"given":"Kohei","family":"Ishibashi","sequence":"additional","affiliation":[{"name":"National Cerebral and Cardiovascular Center, Suita, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7900-7835","authenticated-orcid":false,"given":"Koshiro","family":"Kanaoka","sequence":"additional","affiliation":[{"name":"Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenzaburo","family":"Nakajima","sequence":"additional","affiliation":[{"name":"National Cerebral and Cardiovascular Center, Suita, 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P1603Efficacy of combination therapy of methotrexate and low-dose corticosteroid for cardiac sarcoidosis evaluated by fuluorine-18 fluorodeoxyglucose positron emission tomography. 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