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Introduction: Cardiac sarcoidosis is increasingly recognized as a cause of cardiomyopathy and mortality. However, there are no data on sex differences in patients with suspected cardiac sarcoidosis. Hypothesis: We hypothesized that sex differences exist in the clinical presentation, cardiac involvement, and long-term clinical outcomes of patients with suspected cardiac sarcoidosis. Methods: We performed a retrospective cohort study to examine sex differences in presenting features, CMR findings, and the long-term incidence of adverse clinical outcomes among consecutive patients with histologically proven sarcoidosis and suspected cardiac involvement investigated by cardiovascular magnetic resonance imaging (CMR). The primary composite clinical endpoint was all-cause mortality or significant ventricular arrhythmia. The secondary endpoints were all-cause mortality and significant ventricular arrhythmia. Results: Among 324 patients, 163 (50.3%) were women and 161 (49.7%) were men. Women reported a greater prevalence of chest pain and palpitations than men, but not dyspnea, presyncope, or syncope. Women were less likely to have LGE or meet the criteria for a clinical diagnosis of cardiac sarcoidosis, indicating lesser cardiac involvement. The long-term incidence of the primary composite endpoint (hazard ratio for women 1.36; 95% confidence interval 0.77-2.43; p = 0.29; Figure 1 ) or the cause of death between women and men (p = 0.62). However, women had a significantly lower cumulative incidence of significant ventricular arrhythmia compared with men (4.3% vs. 13.0%; log-rank p = 0.022). Conclusions: There were distinct sex differences in patients with histologically proven sarcoidosis and suspected cardiac involvement. A paradox was noted wherein women had a greater prevalence of chest pain and palpitations than men, but had lesser cardiac involvement, and a similar long-term incidence of all-cause death or significant ventricular arrhythmia.