Papillary fibroelastomas (PFEs) followed by cardiac myxomas (CM) are the 2 most common primary benign cardiac tumors. Although typically asymptomatic, they can manifest with nonspecific symptoms such as dyspnea and dizziness or more acute manifestations such as embolic events. We describe an unusual location of a PFE typically seen with a CM. A 66-year-old woman presented with shortness of breath and dizziness. An echocardiogram revealed a left atrial mass suggestive of a CM, which was surgically removed. Histopathologic examination surprisingly confirmed it to be a PFE. This case highlights the importance of considering PFEs in the differential diagnosis of atrial masses because they can mimic CM clinically and radiographically, thus emphasizing the role of histopathologic examination for definitive diagnosis.
The aim of this prospective, double-blinded study in patients with aortic sclerosis was to determine whether a new calcification propensity measure in the serum could predict disease progression.We included 129 consecutive patients with aortic sclerosis as assessed during a routine clinical echocardiographic exam. Clinical, echocardiographic, and serum laboratory parameters were collected, including a new blood test providing an overall measure of calcification propensity by monitoring the maturation time of calciprotein particles (T50 test). The echocardiographic exam was repeated after 1 year. Multiple regression analysis was performed to identify independent predictors of the annual increase of peak transvalvular Doppler velocity (∆vmax). Furthermore, the accuracy of the T50 test to detect patients with the most marked stenosis progression was assessed by receiver operating characteristic (ROC)-analysis.Mean age was 75 ± 9 years, 79% were men. The T50 was 271 ± 58 min. Overall, there was no significant stenosis progression between baseline and follow-up (∆vmax 3.8 ± 29.8 cm/s, p = ns). The T50 test was not found to be an independent linear predictor in multivariate testing. By ROC-analysis, however, a T50-value ≤ 242 min was able to significantly detect a ∆vmax above the 90th percentile (∆vmax ≥ 43 cm/s, AUC = 0.67, p = .04, Sensitivity = 69%, Specificity = 70%).The T50 test showed a modest but significant ability to identify a pronounced aortic stenosis progression in patients with aortic sclerosis. The test could not be established as an independent linear predictor of disease progression, possibly due to the low valvular disease burden and short follow-up interval.
Background: Systemic sclerosis (SSc) can impact multiple areas of the heart through fibrotic and vascular processes; leading to variable cardiac involvement including electrocardiogram (ECG) abnormalities. Conduction and rhythm disorders are associated with worse prognosis in patients with SSc. (1, 2) Objectives: To study the incidence, risk factors and outcomes of conduction and rhythm disorders in a US population-based cohort of patients with SSc and non-SSc comparators from the same geographic area. Methods: A previously identified incident cohort of SSc patients (1980-2016) in a well-defined geographic area was compared to a randomly selected 2:1 cohort of age- and sex-matched non-SSc subjects from the same population base. Demographics, disease characteristics, cardiovascular risk factors and laboratory tests were abstracted by manual record review. ECGs and Holter ECGs were reviewed to determine the occurrence of any conduction or rhythm abnormalities. The need for cardiac interventions was also abstracted. Results: 78 incident SSc cases and 156 non-SSc comparators were identified [age 56 years± 15.7, 91% female]. Prevalence of any conduction disorders before SSc diagnosis compared to non-SSc comparators was 15% vs. 7% (p=0.06), and any rhythm disorder was 18% vs. 13% (p=0.33). During a median follow up of 10.5 years in patients with SSc and 13.0 years in non-SSc comparators, conduction disorders developed in 25 SSc patients with a cumulative incidence (ci) of 20.5% (95% CI: 12.4-34.1%) compared to 28 non-SSc patients with ci of 10.4% (95% CI: 6.2-17.4%) (HR: 2.57; 95% CI: 1.48-4.45), while rhythm disorders developed in 27 SSc patients with ci of 27.3% (95% CI: 17.9-41.6%) vs 43 non-SSc patients with ci of 18.0% (95% CI: 12.3-26.4%) (HR: 1.62; 95% CI: 1.00-2.64). (Figure 1). Conduction disorders in patients with SSc during follow up included: 1st-degree atrioventricular block (AVB) (n=12), 2nd-degree AVB (n=1), 3rd-degree AVB (n=1), right bundle branch block (n=10), left bundle branch block (n=4), bifascicular block (n=6), and prolonged-QT (n=13). Rhythm disorders included: atrial fibrillation (n=10), atrial flutter (n=4), supraventricular tachycardia (n=4), ventricular tachycardia (n=1), and premature ventricular contractions (n=16). Pulmonary hypertension (PHT) was the only significant risk factor identified for development of both conduction and rhythm disorders (HR=8.38, 95% CI: 1.32-53.40 and HR=8.07, 95% CI: 1.60-40.74, respectively). Current smoking significantly increased the risk for development of rhythm disorders (HR=2.91, 95% CI: 1.19-7.12). Conduction and rhythm disorders were associated with increased mortality among patients with SSc (HR=7.60, 95% CI: 3.49-16.55 and HR=4.87, 95% CI: 2.28-10.42, respectively, after adjusting for age, sex and calendar year of diagnosis). Conclusion: Patients with SSc have a significantly higher prevalence of conduction disorders at disease onset than non-SSc comparators. During the course of their disease, their risk of developing conduction disorders is 2.6-fold, and risk of rhythm disorders is 1.6-fold increased, compared to non-SSc subjects. PHT was significantly associated with increased risk of developing conduction and rhythm disorders among patients with SSc, a finding that should warrant increased vigilance and screening for ECG abnormalities in this population. References: [1]Tyndall A.J. et al. Ann Rheum Dis, 2010. 69(10): p. 1809-15. [2]Desai C.S. et al. Curr Opin Rheumatol, 2011. 23(6): p. 545-54. Figure 1. Cumulative incidence of any conduction or any rhythm disorder in SSc (solid line) vs non-SSc comparators (dashed line). Disclosure of Interests: None declared
Abstract Aims Echocardiographic assessment of cancer-associated non-bacterial thrombotic endocarditis (Ca-NBTE) is limited to case reports and small clinical series. The study aimed to identify heart valve abnormalities and its relation to embolic complications and cancer types. Methods and results Manual review of echocardiographic images and medical records of Mayo Clinic patients (31 March 2002–30 June 2022) was performed. Ca-NBTE in 111 patients (mean age 63.2 ± 9.7 years, 66.7% female) predominantly affected mitral valves (MV) (69), 56 aortic (AV), 8 tricuspid (TV), and rarely pulmonic (PV) (1). In 18 patients, 2 valves were involved, 3 and 4 valve involvement in only a single patient each. Embolic complications were prevalent (n = 102, 91.9%). Ca-NBTE affected MV more frequently on the upstream (atrial) (90% vs. 49.3%) and TV downstream (ventricular) side (75% vs. 37.5%). NBTE size (cm) varied significantly among valves, with TV hosting the largest masses (0.63–2.40 × 0.39–1.77), compared with MV [(0.11–1.81 × 0.11–1.62), (length P = 0.001; width P = 0.03)] and AV [(0.20–2.70 × 0.11–1.51), (length P = 0.001; width P = 0.056)]; MV masses were borderline longer in systemic compared with cerebral emboli (P = 0.057). Majority of MV (79.6%) and AV (69.6%) had thickened leaflets. NBTE lesions commonly affected closing margins (73.9% MV, 85.7% AV, and 62.5% of TV) but rarely commissures of MV (8.7%), yet fairly frequently of AV (41.1%). Five patients had severe regurgitation of MV and 5 AV. Conclusion Ca-NBTE manifests mainly as thrombotic mobile masses attached to thickened MV and AV, with distinct variations in size based on valve type. Embolic destination but not cancer type is associated with NBTE mass size and location.
