1
|
Magodoro IM, Guerrero-Chalela CE, Claggett B, Jermy S, Samuels P, Myer L, Zar HJ, Jao J, Ntsekhe M, Siedner MJ, Ntusi NAB. Cardioprotective effects of early versus late initiated antiretroviral treatment in adolescents with perinatal HIV-1 infection. Sci Rep 2024; 14:14234. [PMID: 38902326 PMCID: PMC11189904 DOI: 10.1038/s41598-024-65119-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/17/2024] [Indexed: 06/22/2024] Open
Abstract
Whether, and how, cardioprotective effects of antiretroviral treatment (ART) in adolescents with perinatal HIV infection (APHIV) vary with age at treatment initiation is unknown. We used magnetic resonance imaging to compare cardiac status between APHIV initiated on ART at < 5 years of age (early ART, n = 37) and ≥ 5 years of age (delayed ART, n = 34) versus HIV-uninfected peers (n = 21), reporting z-score mean differences adjusted for confounders. Relative to HIV-uninfected adolescents, APHIV with early ART had higher left ventricular (LV) global circumferential strain (GCS) [adjusted mean (95%CI) z-score: 0.53 (0.13, 0.92)] and maximum indexed left atrium volume (LAVi) [adjusted z-score: 0.55 (0.08, 1.02)]. In contrast, APHIV with delayed ART had greater indexed LV end-diastolic volume (LVEDVi) [adjusted z-score: 0.47 (0.09, 0.86)] and extracellular volume fraction [adjusted z-score: 0.79 (0.20, 1.37)], but lower GCS [adjusted z-score: -0.51 (-0.91, -0.10)] than HIV-uninfected peers. APHIV had distinct albeit subclinical cardiac phenotypes depending on ART initiation age. Changes in early ART suggested comparatively worse diastology with preserved systolic function while delayed ART was associated with comparatively increased diffuse fibrosis and LV dilatation with reduced systolic function. The long-term clinical significance of these changes remains to be determined.
Collapse
Affiliation(s)
- Itai M Magodoro
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, J46, Old Main Building, Main Road, Observatory, Cape Town, 7925, South Africa.
| | | | - Brian Claggett
- Cardiology Division, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephen Jermy
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Petronella Samuels
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- SA-MRC Unit on Child and Adolescent Health, Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Jennifer Jao
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Adult Infectious Diseases, Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mpiko Ntsekhe
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, J46, Old Main Building, Main Road, Observatory, Cape Town, 7925, South Africa
| | - Mark J Siedner
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Ntobeko A B Ntusi
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, J46, Old Main Building, Main Road, Observatory, Cape Town, 7925, South Africa.
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa.
- South African Medical Research Council Extramural Unit on Noncommunicable Diseases and Infectious Diseases, Cape Town, South Africa.
- ARUA/Guild Cluster of Research Excellence on Noncommunicable Diseases and Associated Multimorbidity, CAPETOWN, South Africa.
| |
Collapse
|
2
|
Magodoro IM, Guerrero-Chalela CE, Claggett B, Jermy S, Samuels P, Myer L, Zar H, Jao J, Ntsekhe M, Siedner MJ, Ntusi NA. Cardioprotective effects of antiretroviral treatment in adolescents with perinatal HIV infection are heterogeneous depending on age at treatment initiation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.08.24303983. [PMID: 38496449 PMCID: PMC10942535 DOI: 10.1101/2024.03.08.24303983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The cardioprotective effects of antiretroviral treatment (ART) in adolescents with perinatal HIV infection (APHIV) may depend on age at ART initiation. We used cardiovascular magnetic resonance (CMR) to characterize and compare residual cardiac changes in apparently healthy APHIV with early and delayed ART initiation compared to sex- and age-similar HIV uninfected peers. We defined early and delayed ART as, respectively, treatment initiated at <5 years and ≥5 years of age. Cardiac function, mechanical deformation, geometry and tissue composition were assessed. APHIV had distinct albeit subclinical cardiac phenotypes depending on timing of ART initiation. For example, changes in early ART suggested comparatively worse diastology with preserved systolic function while delayed ART was associated with comparatively increased diffuse fibrosis and LV dilatation with reduced systolic function. The long-term clinical significance of these changes remains to be determined.
Collapse
|
3
|
Awoyemi T, Gustafson A, Sekhon S, Rytych J, Narang A, Akhter N. Stepwise Use of Multimodality Imaging in a Rare Cardiac Intimal Sarcoma. CASE (PHILADELPHIA, PA.) 2023; 7:409-415. [PMID: 37970486 PMCID: PMC10635890 DOI: 10.1016/j.case.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
•CISs are rare and aggressive primary cardiac tumors. •CIS presents with diverse pathology and is challenging to manage due to mass effect. •Multimodality cardiac imaging is valuable in diagnosis, surveillance, and management. •Because of limited therapeutic options, earlier diagnosis of CIS is essential.
Collapse
Affiliation(s)
| | - Andrew Gustafson
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Shaundeep Sekhon
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jennifer Rytych
- Department of Pathology, Northwestern University, Chicago, Illinois
| | - Akhil Narang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Nausheen Akhter
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Cardiology, Northwestern University, Chicago, Illinois
| |
Collapse
|
4
|
Gaisendrees C, Schlachtenberger G, Walter S, Gerfer S, Djordjevic I, Krasivskyi I, Cagman B, Weber C, Jaeger D, Kosmopoulos M, Luehr M, Mader N, Wahlers T. Long-term outcomes after minimal right lateral thoracotomy for the resection of cardiac tumors. Surg Oncol 2023; 49:101952. [PMID: 37285759 DOI: 10.1016/j.suronc.2023.101952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/15/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Cardiac tumors are a rare and heterogeneous entity, with a cumulative incidence of up to 0.02%. This study aimed to investigate one of the largest patient cohorts for long-term outcomes after minimally-invasive cardiac surgery using right-anterior thoracotomy and femoral cardiopulmonary bypass (CPB) cannulation. METHODS Between 2009 and 2021, patients who underwent minimally-invasive cardiac tumor removal at our department were included. The diagnosis was confirmed postoperatively by (immune-) histopathological analysis. Preoperative baseline characteristics, intraoperative data, and long-term survival were analyzed. RESULTS Between 2009 and 2021, 183 consecutive patients underwent surgery for a cardiac tumor at our department. Of these, n = 74 (40%) were operated on using a minimally-invasive approach. The majority, n = 73 (98.6%), had a benign cardiac tumor, and 1 (1.4%) had a malignant cardiac tumor. The mean age was 60 ± 14 years, and n = 45 (61%) of patients were female. The largest group of tumors was myxoma (n = 62; 84%). Tumors were predominantly located in the left atrium in 89% (n = 66). CPB-time was 97 ± 36min and aortic cross-clamp time 43 ± 24 min s. The mean hospital stay was 9.7 ± 4.5 days. The perioperative mortality was 0%, and all-cause mortality after ten years was 4.1%. CONCLUSION Minimally-invasive tumor excision is feasible and safe, predominantly in benign cardiac tumors, even in combination with concurrent procedures. Patients who require cardiac tumor removal should be evaluated for minimally-invasive cardiac surgery at a specialized center, as it is highly effective and associated with good long-term survival.
Collapse
Affiliation(s)
- Christopher Gaisendrees
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany.
| | - Georg Schlachtenberger
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Sebastian Walter
- University Hospital Cologne, Department of Orthopaedics, Cologne, Germany
| | - Stephen Gerfer
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Ilija Djordjevic
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Ihor Krasivskyi
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Burak Cagman
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Carolyn Weber
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Deborah Jaeger
- Emergency Department, University Hospital of Nancy, Nancy, France
| | - Marinos Kosmopoulos
- Center for Resuscitation Medicine, University of Minnesota, Minneapolis, USA
| | - Maximilian Luehr
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Navid Mader
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Thorsten Wahlers
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| |
Collapse
|
5
|
Rasekhi RT, Hosseini N, Babapoor-Farrokhran S, Farrokhran AB, Behzad B. A rare case of primary adult cardiac rhabdomyosarcoma with lower extremity metastasis. Radiol Case Rep 2023; 18:1666-1670. [PMID: 36873043 PMCID: PMC9982449 DOI: 10.1016/j.radcr.2023.01.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 01/26/2023] [Indexed: 02/27/2023] Open
Abstract
Primary cardiac tumors are uncommon. Rhabdomyosarcomas are among the rarest type of cardiac sarcomas. Echocardiography, cardiac MRI, and computed tomography scan can help the diagnosis and presurgical management. In this article, we report a rare case of primary cardiac rhabdomyosarcoma originating from the mitral valve with left femoral metastasis in a patient in her 60s. The diagnosis was made using transesophageal echocardiography and cardiac MRI. A metastatic lesion was found in an extended PET scan in one of her clinical follow-ups due to her leg pain. Based on this report, we suggest that extending PET scan to the lower extremities could be helpful in the early diagnosis and treatment of remote metastases of cardiac rhabdomyosarcomas.
Collapse
Affiliation(s)
| | | | - Savalan Babapoor-Farrokhran
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY, USA
| | | | - Barzin Behzad
- Department of Radiology, Division of Musculoskeletal, University of Pennsylvania, 3737 Market St, Mialbox #4, Philadelphia, PA 19104
| |
Collapse
|
6
|
QUAH KHK, FOO JS, KOH CH. Approach to Cardiac Masses Using Multimodal Cardiac Imaging. Curr Probl Cardiol 2023; 48:101731. [PMID: 37030421 DOI: 10.1016/j.cpcardiol.2023.101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023]
Abstract
Incidental cardiac masses can pose diagnostic challenges given the numerous differentials, and difficulty in obtaining tissue confirmation without invasive procedures. With recent advancements in cardiac imaging technology, non-invasive efforts to diagnose the intracardiac lesions have become more surmountable. In this paper, we report a case of a patient incidentally found to have an intra-cardiac mass during routine evaluation. Transthoracic echocardiography demonstrated a small mass attached to the tricuspid valve, which was not visualized on follow up cardiac magnetic resonance imaging. Here, we review the currently available cardiac imaging modalities and discuss their values and limitations. From this, we also propose a workflow in the approach to utilizing different imaging modalities to reach a conclusive diagnosis of undifferentiated cardiac masses.
Collapse
|
7
|
Khan WJ, Asif M, Nadeem I, Aslam S, Chowdhury MA. Diagnostic and Therapeutic Challenges Associated With Left Ventricular Tumors. Cureus 2023; 15:e36443. [PMID: 37090366 PMCID: PMC10116074 DOI: 10.7759/cureus.36443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/25/2023] Open
Abstract
Cardiac tumors are uncommon. Sometimes it is challenging to differentiate non-invasively between different kinds of cardiac tumors and thrombi, which is critical to dictate the subsequent treatment. In addition, not all high-risk cardiac tumors are amenable to surgical resection posing a therapeutic challenge. We report a case of cardiac papillary fibroelastoma in the left ventricular cavity with a 10-year follow-up, with no embolic complications.
Collapse
Affiliation(s)
- Wahab J Khan
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Muhammad Asif
- Internal Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, USA
| | - Ifrah Nadeem
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Sadia Aslam
- Internal Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, USA
| | | |
Collapse
|
8
|
Huge right ventricular myxoma in a 15-year-old female patient: a case report and literature review. THE CARDIOTHORACIC SURGEON 2023. [DOI: 10.1186/s43057-023-00095-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Abstract
Background
Myxomas represent about 5–10% of primary cardiac tumors in children, and only about 2.5–4% of cardiac myxomas originate from ventricular chambers. Symptoms and signs of right ventricular tumors depend mainly on the size and the site of the tumor and its effect on the inflow and outflow of the blood.
Case presentation
A 15-year-old female patient presented with syncope on exertion and symptoms and signs of congestive heart failure. She had a history of dyspnea and palpitation on exertion for 2 years before admission. Echocardiography and cardiac magnetic resonance imaging (MRI) diagnose a huge right ventricular mobile mass (9 × 4.6 × 3.7 cm) prolapsing during systole into the main pulmonary artery and severe tricuspid regurgitation. The mass showed no contrast enhancement in early dynamic and delayed gadolinium images, suggestive of a thrombus. The mass was safely excised and tricuspid annuloplasty repair was done using right atriotomy and vertical right ventriculotomy approaches. The patient was discharged in a well condition on postoperative day 6. Pathologically, the mass was confirmed as cardiac myxoma with old extensive hemorrhage inside.
Conclusions
Early echocardiography is essential for patients complaining of unexplained cardiac symptoms for early diagnosis and management of rare cases. Multimodality imaging is needed for the diagnosis and planning of the surgical procedure of right ventricular masses. Hemorrhage inside myxoma may lead to no contrast enhancement of the tumor.
Collapse
|
9
|
A rare case of left atrial myxofibromyosarcoma. Radiol Case Rep 2022; 18:771-774. [PMID: 36589498 PMCID: PMC9794883 DOI: 10.1016/j.radcr.2022.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
Myxofibrosarcoma is an aggressive soft tissue sarcoma, previously known as myxoid variant of malignant fibrous histiocytoma. Primary cardiac myxofibrosarcomas are the rarest forms of cardiac malignant tumors that often remain asymptomatic until metastasis occurs. In this case report, we describe a rare left atrial cardiac myxofibrosarcoma in a patient with recurrent renal cell carcinoma. We discuss the multimodality imaging approach to diagnose and evaluate cardiac masses as well as imaging characteristics to differentiate cardiac masses from thrombus.
Collapse
|
10
|
Baldassarre LA, Ganatra S, Lopez-Mattei J, Yang EH, Zaha VG, Wong TC, Ayoub C, DeCara JM, Dent S, Deswal A, Ghosh AK, Henry M, Khemka A, Leja M, Rudski L, Villarraga HR, Liu JE, Barac A, Scherrer-Crosbie M. Advances in Multimodality Imaging in Cardio-Oncology: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:1560-1578. [PMID: 36229093 DOI: 10.1016/j.jacc.2022.08.743] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/07/2022]
Abstract
The population of patients with cancer is rapidly expanding, and the diagnosis and monitoring of cardiovascular complications greatly rely on imaging. Numerous advances in the field of cardio-oncology and imaging have occurred in recent years. This review presents updated and practical approaches for multimodality cardiovascular imaging in the cardio-oncology patient and provides recommendations for imaging to detect the myriad of adverse cardiovascular effects associated with antineoplastic therapy, such as cardiomyopathy, atherosclerosis, vascular toxicity, myocarditis, valve disease, and cardiac masses. Uniquely, we address the role of cardiovascular imaging in patients with pre-existing cardiomyopathy, pregnant patients, long-term survivors, and populations with limited resources. We also address future avenues of investigation and opportunities for artificial intelligence applications in cardio-oncology imaging. This review provides a uniform practical approach to cardiovascular imaging for patients with cancer.
Collapse
Affiliation(s)
- Lauren A Baldassarre
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarju Ganatra
- Cardio-Oncology and Cardiac MRI Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Juan Lopez-Mattei
- Cardiovascular Imaging Program, Department of Cardiovascular Medicine, Lee Health, Fort Myers, Florida, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Vlad G Zaha
- Cardio-Oncology Program, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Timothy C Wong
- UPMC Cardiovascular Magnetic Resonance Center, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Chadi Ayoub
- Division of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jeanne M DeCara
- Cardio-Oncology Program, Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arjun K Ghosh
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Cardio-Oncology Service, University College London Hospital and Hatter Cardiovascular Institute, London, United Kingdom
| | - Mariana Henry
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Abhishek Khemka
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Monika Leja
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lawrence Rudski
- Azrieli Heart Center, Department of Medicine, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Hector R Villarraga
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jennifer E Liu
- Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ana Barac
- Medstar Heart and Vascular Institute, Georgetown University, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marielle Scherrer-Crosbie
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
11
|
Bugra Z, Emet S, Umman B, Ozer PK, Sezer M, Baykiz D, Atilgan D, Tireli E, Dursun M, Yılmazbayhan D, Karaayvaz EB, Elitok A, Bilge AK, Goren T, Umman S, Kumrular M, Yilmaz M, Sonsoz MR, Engin B, Ayduk E, Aydogan M, Cevik E, Kavak I, Orta H, Tasdemir M, Tuncozgur A, Topcak Z, Gorgun OD, Oztas DM. Intracardiac masses: Single center experience within 12 years: I-MASS Study. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100081. [PMID: 38560087 PMCID: PMC10978191 DOI: 10.1016/j.ahjo.2021.100081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/27/2021] [Accepted: 12/07/2021] [Indexed: 04/04/2024]
Abstract
Objective The aim of this cross-sectional, retrospective, descriptive study was to review and classify cardiac masses systematically and to determine their frequencies. Methods The medical records of 64,862 consecutive patients were investigated within 12 years. Every patient with a cardiac mass imaged by transthoracic echocardiography (TTE) and confirmed with an advanced imaging modality such as transesophageal echocardiography (TEE), computed tomography (CT) and/or cardiac magnetic resonance imaging (CMR) was included. Acute coronary syndromes triggering thrombus formation, vegetations, intracardiac device and catheter related thrombi were excluded. Results Data demonstrated 127 (0.195%) intracardiac masses consisting of 33 (0.050%) primary benign, 3 (0.004%) primary malignant, 20 (0.030%) secondary tumors, 3 (0.004%) hydatid cysts and 68 (0.104%) thrombi respectively. The majority of primary cardiac tumors were benign (91.67%), predominantly myxomas (78.79%), and the less malignant (8.33%). Secondary cardiac tumors were common than the primary malignant tumors (20:3), with male dominancy (55%), lymphoma and lung cancers were the most frequent. Intracardiac thrombi was the majority of the cardiac masses, thrombi accompanying malignancies were in the first range (n = 17, 25%), followed by autoimmune diseases (n = 13, 19.12%) and ischemic heart disease with low ejection fraction (n = 12, 17.65%). Conclusions This retrospective analysis identified 127 patients with cardiac masses. The majority of benign tumors were myxoma, the most common tumors that metastasized to the heart were lymphoma and lung cancers, and the thrombi associated with malignancies and autoimmune diseases were the most frequent.
Collapse
Affiliation(s)
- Zehra Bugra
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Samim Emet
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Berrin Umman
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Pelin Karaca Ozer
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Murat Sezer
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Derya Baykiz
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Dursun Atilgan
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Emin Tireli
- Istanbul University, Istanbul Medical Faculty, Department of Cardiovascular Surgery, Turkey
| | - Memduh Dursun
- Istanbul University, Istanbul Medical Faculty, Department of Radiology, Turkey
| | - Dilek Yılmazbayhan
- Istanbul University, Istanbul Medical Faculty, Department of Pathology, Turkey
| | | | - Ali Elitok
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Ahmet Kaya Bilge
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Taner Goren
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Sabahattin Umman
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Collaborators
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
- Istanbul University, Istanbul Medical Faculty, Department of Cardiovascular Surgery, Turkey
- Istanbul University, Istanbul Medical Faculty, Department of Radiology, Turkey
- Istanbul University, Istanbul Medical Faculty, Department of Pathology, Turkey
| | - Merve Kumrular
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Mustafa Yilmaz
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Mehmet Rasih Sonsoz
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Berat Engin
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Elif Ayduk
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Mehmet Aydogan
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Erdem Cevik
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Ilyas Kavak
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Huseyin Orta
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Mucahit Tasdemir
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Asli Tuncozgur
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Zeynep Topcak
- Istanbul University, Istanbul Medical Faculty, Department of Cardiology, Turkey
| | - Ozerk Dogus Gorgun
- Istanbul University, Istanbul Medical Faculty, Department of Pathology, Turkey
| | - Didem Melis Oztas
- Istanbul University, Istanbul Medical Faculty, Department of Cardiovascular Surgery, Turkey
| |
Collapse
|
12
|
Abstract
Since its beginning, 30 years ago, magnetic resonance imaging of the heart made tremendous progress. Starting from an almost experimental level in the 90 s it has now become a routine tool within cardiac diagnostics. This article presents a selection of present applications of cardiac magnetic resonance imaging. Besides it superiority in determining mass and volumes of the heart, structural imaging of myocardial tissue has become the domain of cardiac magnetic resonance imaging. This implies detection and quantification of scars and fibrosis, inflammatory and infiltrative processes in myocarditis and amyloidosis, and characterization of cardiac tumors. Perfusion imaging allows detection of ischemia, and measurement of blood flow quantifies cardiac shunts and valve disorders. In combination with Positron Emission Tomography, the relationship of molecular/cellular processes and functional, microstructural alterations become visible in myocarditis and amyloidosis. Recent contraindications of cMRI/MRI as cardiac devices MRI have been resolved; however, image quality of the heart is still a challenge.
Collapse
|
13
|
Affiliation(s)
- Sneha Thatipelli
- Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Sasan Raissi
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Nausheen Akhter
- Feinberg School of Medicine, Division of Cardiology, Department of Medicine, Northwestern University, Chicago
| |
Collapse
|
14
|
Vemuri KS, Revaiah PC, Bootla D, Chauhan R, Nevali KP, Jandial A, Singh Sachdeva MU, Singh D, Rohit MK. Early T Cell Precursor Leukemia Presenting With Superior Vena Cava Syndrome and Cardiac Tamponade. JACC CardioOncol 2020; 2:805-809. [PMID: 34396298 PMCID: PMC8352309 DOI: 10.1016/j.jaccao.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Krishna Santosh Vemuri
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Pruthvi C. Revaiah
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Dinakar Bootla
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rajeev Chauhan
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Krishna Prasad Nevali
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Aditya Jandial
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Man Updesh Singh Sachdeva
- Department of Hematology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Dushyant Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
15
|
Pulmonary MRI: Applications and Use Cases. CURRENT PULMONOLOGY REPORTS 2020. [DOI: 10.1007/s13665-020-00257-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
16
|
Lopez-Mattei JC, Lu Y. Multimodality Imaging in Cardiac Masses: To Standardize Recommendations, The Time Is Now! JACC Cardiovasc Imaging 2020; 13:2412-2414. [PMID: 32563655 DOI: 10.1016/j.jcmg.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Juan C Lopez-Mattei
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Thoracic Imaging, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Yang Lu
- Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
17
|
Tyebally S, Chen D, Bhattacharyya S, Mughrabi A, Hussain Z, Manisty C, Westwood M, Ghosh AK, Guha A. Cardiac Tumors: JACC CardioOncology State-of-the-Art Review. JACC: CARDIOONCOLOGY 2020; 2:293-311. [PMID: 34396236 PMCID: PMC8352246 DOI: 10.1016/j.jaccao.2020.05.009] [Citation(s) in RCA: 195] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
Abstract
Cardiac masses are rare, but remain an important component of cardio-oncology practice. These include benign tumors, malignant tumors (primary and secondary) and tumor-like conditions (e.g., thrombus, Lambl’s excrescences, and pericardial cyst). The advent of multimodality imaging has enabled identification of the etiology of cardiac masses in many cases, especially in conjunction with information from clinical settings. This paper provides a comprehensive review of the epidemiology, clinical presentation, imaging, diagnosis, management, and outcomes of cardiac masses. Cardiac tumors are rare and should be considered as part of the differential diagnosis of any space-occupying mass noted on cardiovascular and/or thoracic imaging modalities. It may be possible to get close to a diagnosis without biopsy using a structured imaging approach. The prognosis and treatment of each tumor is different, although early diagnosis is usually associated with a better outcome.
Collapse
Affiliation(s)
- Sara Tyebally
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Daniel Chen
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Cardio-Oncology Service, University College London Hospital, London, United Kingdom
| | - Sanjeev Bhattacharyya
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Abdallah Mughrabi
- Jordan University of Science and Technology, Al Ramtha, Irbid, Jordan
| | - Zeeshan Hussain
- Division of Cardiology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Charlotte Manisty
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Mark Westwood
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Arjun K Ghosh
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Cardio-Oncology Service, University College London Hospital, London, United Kingdom
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, Ohio, USA.,Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|