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Rahouma M, Khairallah S, Dabsha A, Elkharbotly IAMH, Baudo M, Ismail A, Korani OM, Hossny M, Dimagli A, Girardi LN, Mick SL, Gaudino M. Lung Cancer as a Leading Cause among Paraneoplastic Non-Bacterial Thrombotic Endocarditis: A Meta-Analysis of Individual Patients' Data. Cancers (Basel) 2023; 15:cancers15061848. [PMID: 36980734 PMCID: PMC10047261 DOI: 10.3390/cancers15061848] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Hypercoagulability is strongly associated with cancer and may result in non-bacterial thrombotic endocarditis (NBTE). The aim of our meta-analysis was to explore the demographics and characteristics of this condition in cancer. Databases were systematically searched. The outcomes were to identify the annual trend in premortem diagnosis among the entire cohort and different subgroups and to identify differences in characteristics and survival in the considered population. A total of 121 studies with 144 patients were included. The proportion of marantic endocarditis associated with lung cancer was 0.29 (95% CI, 0.21-0.37; p < 0.001), that associated with pancreatic cancer was 0.19 (95% CI, 0.13-0.27; p < 0.001), that associated with advanced cancer stage (metastasis) was 0.69 (95% CI, 0.61-0.76; p < 0.001), and that associated with adenocarcinoma was 0.65 (95% CI, 0.56-0.72; p < 0.001). Median and 6-month overall survival (OS) were 1.3 months and 32.3%, respectively, with 6-month OS of 20.8% vs. 37.0% in lung vs. other cancers, respectively (p = 0.06) and 42.9% vs. 31.1% among those who underwent intervention vs. those who did not (p = 0.07). Cases discovered in recent years had better survival (HR = 0.98 (95% CI, 0.96-0.99; p = 0.003). While cancer-associated NBTE is a rare entity, lung cancers were the most common tumor site and are frequently associated with more advanced and metastatic cancer stages. The prognosis is dismal, especially among lung cancers.
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Affiliation(s)
- Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Sherif Khairallah
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Anas Dabsha
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Ismail A M H Elkharbotly
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
- General Surgery Department, Newham University Hospital, London E13 8SL, UK
| | - Massimo Baudo
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Department of Cardiac Surgery, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Amr Ismail
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Omnia M Korani
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Mohamed Hossny
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Stephanie L Mick
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
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Polo J, Raufast D, Cornand D, Elias A. Acute ischaemia of the lower limb due to non-bacterial thrombotic endocarditis with recent venous thrombo-embolic disease as the initial manifestation of lung adenocarcinoma: a case report. Eur Heart J Case Rep 2021; 5:ytab426. [PMID: 34859183 PMCID: PMC8634418 DOI: 10.1093/ehjcr/ytab426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/24/2021] [Accepted: 10/20/2021] [Indexed: 12/01/2022]
Abstract
Background Non-bacterial thrombotic endocarditis is a rare condition. Optimal management is based on early diagnosis which remains difficult. Case summary A 75-year-old male patient was admitted to the hospital with acute ischaemia of the left lower limb due to popliteal artery occlusion despite anticoagulation with rivaroxaban for pulmonary embolism diagnosed 2 weeks earlier. Transoesophageal echocardiography (TOE) showed a mobile vegetation with mild mitral valve regurgitation. Positron emission tomography (PET) scan did not show hyperfixation at the mitral valve but rather lymphadenopathy hyperfixation at different sites. Biopsy of a lymph node from Barety’s space identified a bronchopulmonary adenocarcinoma. The outcome was favourable after popliteal artery thrombectomy and low-molecular-weight heparin treatment. The patient was referred to the department of onco-pneumology for further care. Discussion Upon clinical presentation, the combination of an arterial and prior venous thrombotic event suggested that the origin could be either a patent foramen ovale (PFO) or a thrombosis from an underlying cancer. A transthoracic echocardiography and TOE excluded a PFO and demonstrated a mobile echogenic mass at the mitral valve site together with a mild regurgitation. The diagnosis of non-bacterial thrombotic endocarditis was suggested given the absence of clinical and biological infectious signs, negative blood cultures and serology for endocarditis, the presence of both arterial and venous thrombosis, as well as the presence of intra-thoracic lymphadenopathy hyperfixation on the PET scan for which a biopsy demonstrated lung adenocarcinoma.
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Affiliation(s)
- Julien Polo
- Department of Cardiovascular Medecine, Centre Hospitalier Intercommunal Toulon/La Seyne-sur-Mer, 54 Rue Henri Sainte-Claire Deville, 83100 Toulon, France
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Yao JV, Joshi SB, Morgan JG, Lee MG. An unusual case of non-infective endocarditis in undiagnosed antiphospholipid syndrome. Med J Aust 2021; 215:311-312.e1. [PMID: 34494275 DOI: 10.5694/mja2.51246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/27/2020] [Accepted: 10/01/2020] [Indexed: 01/09/2023]
Affiliation(s)
| | - Subodh B Joshi
- Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | | | - Melissa Gy Lee
- Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
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Gray KM, Nguyen B, Baker L, Ahmad M. Non-bacterial thrombotic endocarditis and coronary thrombectomy in a patient with metastatic small cell lung carcinoma. BMJ Case Rep 2021; 14:14/6/e239893. [PMID: 34155006 DOI: 10.1136/bcr-2020-239893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 66-year-old Caucasian man was initially admitted with a metastatic small cell lung carcinoma, hyponatraemia and obstructive pneumonia. His transthoracic echocardiogram (TTE) was normal. Ten days after admission, he was diagnosed with a non-ST segment elevation myocardial infarction (MI). Both a repeated TTE and a transoesophageal echocardiogram identified thickened, myxomatous mitral valve leaflet tips with small, mobile masses identified as vegetations, and new, eccentric, severe mitral regurgitation. Subsequent cardiac catheterisation recorded thrombotic occlusion of the right coronary artery. Successful coronary thrombectomy was carried out, but the patient died. A diagnosis of non-bacterial thrombotic endocarditis leading to coronary embolisation and MI was made. The clinical course and treatment choices are discussed.
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Affiliation(s)
- Kelsey Margaret Gray
- School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Bao Nguyen
- Division of Cardiology, Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Larissa Baker
- School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Masood Ahmad
- Division of Cardiology, Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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Nabati M, Parsaee H, Fattahian A. Semi-mobile rudimentary tissues attached to a congenital intramitral ring in a woman with previous history of embolic stroke: A rare case report. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2020; 27:191-195. [PMID: 32549899 DOI: 10.1177/1742271x19855103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/14/2019] [Indexed: 11/15/2022]
Abstract
Isolated congenital mitral ring is a very rare subtype of congenital mitral valve malformation, which accounts for about one-third of congenital cardiac anomalies associated with left ventricular inflow obstruction. A mitral ring may be easily missed unless the disease is suspected. The mitral valve repair should be considered in symptomatic patients with mitral stenosis. We report a rare case of a 43-year-old woman with an intramitral ring who experienced previous embolic stroke with left hemiplegia. However, stroke happened several years ago and it does not completely prove causality.
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Affiliation(s)
- Maryam Nabati
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Homa Parsaee
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Fattahian
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Bussani R, DE-Giorgio F, Pesel G, Zandonà L, Sinagra G, Grassi S, Baldi A, Abbate A, Silvestri F. Overview and Comparison of Infectious Endocarditis and Non-infectious Endocarditis: A Review of 814 Autoptic Cases. In Vivo 2020; 33:1565-1572. [PMID: 31471406 DOI: 10.21873/invivo.11638] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 01/09/2023]
Abstract
AIM We examined evidence on infective and non-infective endocarditis obtained from a database of 50,403 clinical autopsies performed at an Italian general hospital between January 1983 and December 2006. MATERIALS AND METHODS Out of 814 endocarditis cases, 409 were of infective endocarditis (IE) and 405 non-infective (NIE). The median age at the time of death was 78 years for those with IE and 83 for those with NIE. Data were collected on gender, clinical history, comorbidities, kind of affected valve (non-prosthetic/mechanical/biological), pathological features of endocarditis, endocarditis complications and microbiological agents. RESULTS The diagnosis of IE was frequently missed and these conditions were often complicated by cardiovascular events. IE was more common among patients with prior valve infection or cardiovascular surgery, while malignancies were frequent comorbidities of NIE. CONCLUSION In general, we found several data that differ from those generally present in the scientific literature, and this could be explained by the fact that data on IE and NIE are generally obtained from surgical and clinical databases, while we analysed only autoptic cases.
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Affiliation(s)
- Rossana Bussani
- Institute of Pathological Anatomy, Riuniti Hospital and University of Trieste, Trieste, Italy
| | - Fabio DE-Giorgio
- Institute of Public Health, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuliano Pesel
- Institute of Pathological Anatomy, Riuniti Hospital and University of Trieste, Trieste, Italy
| | - Lorenzo Zandonà
- Institute of Pathological Anatomy, Riuniti Hospital and University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Riuniti Hospital and University of Trieste, Trieste, Italy
| | - Simone Grassi
- Institute of Public Health, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfonso Baldi
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, L. Vanvitelli University of Campania, Caserta, Italy
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, U.S.A
| | - Furio Silvestri
- Institute of Pathological Anatomy, Riuniti Hospital and University of Trieste, Trieste, Italy
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Tai MLS, Tan ECL, Ang CC, Liam CK. Recurrent cerebral infarcts secondary to marantic endocarditis in a patient with adenocarcinoma of the lung. Singapore Med J 2017; 57:524-5. [PMID: 27663211 DOI: 10.11622/smedj.2016157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Mei-Ling Sharon Tai
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
| | - Eugene Choon Li Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia.,Hospital Angkatan Tentera Tuanku Mizan, Malaysia
| | - Choon Chin Ang
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
| | - Chong-Kin Liam
- Division of Respiratory Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
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Detremerie C, Timmermans F, De Pauw M, Gheeraert P, Hemelsoet D, Toeback J, Bové T, Vandecasteele E. Stroke due to non-bacterial thrombotic endocarditis as initial presentation of breast invasive ductal carcinoma. Acta Clin Belg 2017; 72:268-273. [PMID: 27683971 DOI: 10.1080/17843286.2016.1219012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We present a case of a 71-year-old woman with recurrent stroke episodes due to non-bacterial thrombotic endocarditis (NBTE) leading to the diagnosis of an early-stage breast carcinoma. NBTE is associated with a variety of inflammatory states, including malignancy. NBTE presents itself with systemic embolization, mostly stroke. Treatment consists of treating the underlying condition and start of systemic anticoagulation therapy. Cardiac surgery is restricted to highly selected cases, since prognosis usually is limited by the neoplasm, which usually is in an advanced stage at time of diagnosis of NBTE. The malignancy usually is diagnosed prior to NBTE. Cases presenting with NBTE leading to the diagnosis of malignancy, however, are rarely reported. To our knowledge, we present the first case leading to the diagnosis of an early-stage breast carcinoma.
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Affiliation(s)
| | - Frank Timmermans
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Peter Gheeraert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | - Jonas Toeback
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Thierry Bové
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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Mitma AA, Varghese JG, Witt D, Zarich SW. Stroke and a valvular lesion in a patient with stage IV non-small cell lung cancer. BMJ Case Rep 2016; 2016:bcr-2016-215317. [PMID: 27247207 DOI: 10.1136/bcr-2016-215317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The mechanism and severity of stroke varies in the setting of malignancy. We report a case of a 68-year-old man with lung adenocarcinoma, who experienced acute neurological symptoms. Imaging studies showed multiple acute ischaemic infarcts in cerebral and cerebellar hemispheres. Further work up was consistent with non-bacterial thrombotic endocarditis (NBTE). We highlight, through a review of the literature, the importance of transoesophageal echocardiography (TOE) in defining the above diagnosis. The treatment of NBTE consists of systemic anticoagulation and therapy of the underlying malignancy. Enoxaparin is preferred over warfarin to achieve this goal. He received systemic targeted therapy with erlotinib. A TOE performed 8 months later showed complete resolution of the vegetation.
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Affiliation(s)
- Angel A Mitma
- Department of Internal Medicine, Bridgeport Hospital, Bridgeport, Connecticut, USA Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jithin G Varghese
- Department of Internal Medicine, Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - David Witt
- Yale University School of Medicine, New Haven, Connecticut, USA Yale Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Stuart W Zarich
- Yale University School of Medicine, New Haven, Connecticut, USA Department of Cardiology, Bridgeport Hospital, Bridgeport, Connecticut, USA
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Berlot G, Calderan C, Fiorenza C, Cappelli D, Addesa S, Bussani R. Infective and non-infective endocarditis in critically ill patients: a clinical-pathological study. Intern Emerg Med 2014; 9:773-8. [PMID: 24519321 DOI: 10.1007/s11739-014-1054-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 01/23/2014] [Indexed: 11/24/2022]
Abstract
The aims of this study are to estimate the incidence, the outcome and the associated risk factors of infective and non-infective endocarditis (IE and NIE, respectively) in intensive care unit (ICU) patients. We studied the post-mortem findings and the clinical data of the patients who died in our ICU between 1996 and 2010. Of the 765 reviewed autopsies, 21 patients (2.7%) presented cardiac vegetations. These cases consisted of 12 IEs and 9 NIEs. Three patients with IE had a mechanical prosthetic valve, and in 11 cases invasive devices had been used. Multiple peripheral embolisms were discovered at autopsy. In particular, the brain appeared to be more affected in patients with IE, while pulmonary embolisms were commonly associated with NIE. Blood cultures were positive in nine patients with IE. The imaging diagnostics (transthoracic and transesophageal echocardiography) which were seldom performed in both groups, proved to be of little help. As a consequence, an IE was correctly diagnosed before death in three patients (25%) and suspected in two other cases (17%), while a NIE was diagnosed before death in one patient alone. In conclusions, critically ill patients admitted to general ICUs, multiple factors related both to the underlying conditions and to performed procedures can facilitate the occurrence of IE and NIE making, at the same time, their diagnosis challenging. Many cases, in fact, are diagnosed only at autopsy. Yet again, post-mortem examination proves to be an invaluable tool for the evaluation of diagnostic accuracy in critical care.
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Affiliation(s)
- Giorgio Berlot
- Department of Anaesthesia and Intensive Care, Cattinara Hospital, Strada di Fiume 447, 34149, Trieste, Italy,
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Kim HM, Kim HL, Lee HS, Jung JH, Kim CH, Oh S, Kim JH, Zo JH. Nonbacterial Thrombotic Endocarditis in a Patient with Bowel Infarction due to Mesenteric Vein Thrombosis. Korean Circ J 2014; 44:189-92. [PMID: 24876861 PMCID: PMC4037642 DOI: 10.4070/kcj.2014.44.3.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 10/14/2013] [Accepted: 10/15/2013] [Indexed: 11/19/2022] Open
Abstract
Ante mortem cases of venous thrombosis in patients with nonbacterial thrombotic endocarditis (NBTE) have not yet been reported. We describe a rare case of NBTE in a patient with mesenteric vein thrombosis. A healthy 37-year-old man with abdominal pain and fever underwent emergency small bowel resection due to bowel ischemia resulting from mesenteric vein thrombosis. Transthoracic echocardiography revealed multiple mobile masses attached to the anterior leaflet of the mitral valves and their chordae tendineae. On suspicion of infective endocarditis, the cardiac masses were excised through open-heart surgery. However, pathologic reviews were compatible with NBTE. The patient was stable after the cardiac surgery and was treated with warfarin. Laboratory and imaging findings regarding his hypercoagulable condition were all negative.
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Affiliation(s)
- Hyue Mee Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hack-Lyoung Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Seung Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Hyun Jung
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chee Hae Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sooyeon Oh
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ho Kim
- Department of Pathology, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Joo-Hee Zo
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Hejna P, Janík M, Dobiáš M. Tricuspid valve endocarditis complicated by septic pulmonary embolism in an intravenous drug user. Forensic Sci Med Pathol 2013; 10:126-9. [DOI: 10.1007/s12024-013-9485-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2013] [Indexed: 11/24/2022]
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