Clinical Significance of Angiographically Detectable Neovascularity in Patients with Cardiac Myxoma

Abstract

Background: Myxomas are the most common primary cardiac tumors. Angiographically detectable neovascularity (ADN) of myxoma is increasingly being reported as a result of the use of coronary angiography (CAG) to detect coronary artery disease. However, the clinical significance of these findings is not fully understood.Methods: We enrolled 59 patients with cardiac myxoma who also underwent CAG between January 2013 and October 2018. Patients were followed up for a mean of 28.9 months (range 1–69 months). The clinical features, echocardiography measurements, pathological examination findings, CAG results, and outcomes during follow-up were compared between patients with ADN and patients without ADN.Results: ADN was found in 25 patients (42.4%). The arteries feeding the ADN included the right coronary artery(n = 15), the left circumflex coronary artery (n = 7), and both arteries (n = 3). The patients with ADN had a higherproportion of eosinophils (3.2% vs. 2.2%, P = 0.03) and higher low-density lipoprotein cholesterol level (2.7 mmol/L vs.2.2 mmol/L, P = 0.02). Myxoma pedicles were more likely to be located in the interatrial septum in patients with ADN(96% vs. 73.5%, P = 0.02). No significant correlation was observed between the groups in clinical manifestations, atrialarrhythmia, myxoma size, cardiac chamber size, left ventricular ejection fraction, and the prevalence of complicationwith coronary artery disease [16% in the ADN group (n = 4) vs. 20.6% in the non-ADN group (n = 7), P = 0.66].However, patients with ADN tended to have a lower incidence of major adverse cardiac and cerebrovascular events onlong-term follow-up (0% vs. 14.7%, P = 0.07).Conclusion: CAG-detected ADN in patients with cardiac myxoma is associated with a borderline lower rate of major adverse cardiac and cerebrovascular events.