Evaluation of the potential predictors of embolism in patients with left atrial myxoma

Abstract

Introduction: Cardiac myxomas are the most common primary intracardiac tumors.Although myxomas are histologically benign, they are potentially dangerous due to potential risk of systemic and cerebral embolism. In this study, we aimed to investigate the potential predictors of embolism in patients with left atrial myxoma. Methods:This single-center retrospective study enrolled 93 patients (mean age:52.9 ± 15.3 years, female: 70 [75.3%]) with left atrial myxomas between 2014 and 2018. The patients were classified into two groups (embolic vs nonembolic) to investigate possible predictors of embolism. Demographic, laboratory, and echocardiographic parameters were recorded into a dataset and compared between patients with and without embolism. Results:The study population was composed of 13 (14%) patients in embolic (11 cerebrovascular and 2 peripheral) and 80 (86%) patients in nonembolic group.Demographic and laboratory parameters were similar between the groups. Tumor sizes were significantly higher in the embolic group than in the nonembolic group (5.59 ± 1.08 vs 4.29 ± 0.61; P = 0.001). By multivariate analysis, increased tumor size, increased left atrial diameter, and the presence of atrial fibrillation and irregular tumor surface were identified as independent predictors of embolism. In ROC curve analyses, tumor size above 4.6 cm predicted embolism with a sensitivity of 77% and a specificity of 73% (AUC: 0.858; 95% CI: 0.752-0.964; P < 0.001). Conclusion:The presence of atrial fibrillation, irregular tumor surface, increased tumor size, and increased left atrial diameter is associated with increased risk of embolism in patients with left atrial myxoma. Early surgery should be scheduled for such patients due to increased potential for embolism. K E Y W O R D Scardiac imaging, cardiac surgery, echocardiography, embolism, left atrial myxoma, transesophageal echocardiography

Risk factors of embolism for the cardiac myxoma patients: a systematic review and metanalysis

“…In addition, tumor size had high heterogeneity (I 2 = 83.3%), and sensitivity analysis showed a similar trend among studies except for the study by Kalçık et al [ 13 ]. After this study was excluded, the among-study heterogeneity was found to be moderate (I 2 = 58.6%, P = 0.03), while the overall effect did not differ significantly ( P = 0.19).…”

“…Consistent with the previous studies [ 29 – 31 ], the current study found that embolic events are often associated with type 1 myxoma. This correlation might occur because the type 1 myxoma is prone to be friable, which leads to the shedding of tumor fragments into the bloodstream [ 13 ]. In addition, we found that atypical location is a risk factor of embolism.…”

“…Although, several risk factors of embolism are recently reported [ 5 – 16 ], some are controversial. For instance, a previous study [ 17 ] showed that the small size of the tumor was an independent risk factor for embolism, whereas other studies neither found any association [ 14 ] nor presented a contrary conclusion [ 13 ]. Some studies reported that the male gender was associated with an increased risk of embolism [ 18 ], while others failed to find this association [ 6 , 7 ].…”

Atrial Myxoma, a Rare Cause of Sudden Cardiac Death: A Case Report and Review of Literature

“…On immunohistochemical staining, some cardiac myxoma cells are positive for CD31, CD34, and FVIIIAg. They can also stain positive for vimentin, desmin, smooth muscle myosin, CD56, S-100 protein, calretinin, α1 antitrypsin, and α1 antichymotrypsin [12].…”

Mixoma Atrial Esquerdo Envolvendo Manifestações Multissistêmicas em Paciente Idosa

“…evoluem assintomáticos e, quando os sintomas descritos acima se manifestam, são frequentemente confundidos com diversas condições. [4][5][6] O misdiagnosis inicial ocorreu no presente caso: a conjunção de fatores de risco cardiovasculares, a apresentação clínica típica e o diagnóstico anatômico de obstrução coronariana aguda fizeram o mixoma mimetizar doença arterial coronariana como etiologia do infarto.…”