Clinical presentation and neurovascular manifestations of cardiac myxomas and papillary fibroelastomas: a retrospective single-institution cohort study
BackgroundPrimary cardiac tumors are often benign and commonly present as cardiac myxomas (CMs) or papillary fibroelastomas (CPFEs). There is a paucity of prognostic indicators for tumor burden or potential for embolic cerebrovascular events (CVEs). This study was performed to address these gaps.Met...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-09-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1222179/full |
| _version_ | 1797729236151173120 |
|---|---|
| author | Akshay Mathavan Akash Mathavan Urszula Krekora Mohit Mathavan Vanessa Rodriguez Ellery Altshuler Brianna Nguyen Mohammed Ruzieh |
| author_facet | Akshay Mathavan Akash Mathavan Urszula Krekora Mohit Mathavan Vanessa Rodriguez Ellery Altshuler Brianna Nguyen Mohammed Ruzieh |
| author_sort | Akshay Mathavan |
| collection | DOAJ |
| description | BackgroundPrimary cardiac tumors are often benign and commonly present as cardiac myxomas (CMs) or papillary fibroelastomas (CPFEs). There is a paucity of prognostic indicators for tumor burden or potential for embolic cerebrovascular events (CVEs). This study was performed to address these gaps.MethodsMedical records at the University of Florida Health Shands Hospital between 1996 and 2021 were screened to identify patients with CMs or CPFEs. Clinical features, echocardiographic reports, and CVE outcomes were quantitatively assessed.ResultsA total of 55 patients were included in the study: 28 CM (50.9%) and 27 CPFE (49.1%) patients. Baseline patient characteristics were similar among patients. The neutrophil–lymphocyte ratio was correlated (p < 0.005 in all cases) to three metrics of tumor size in both CM (r = 64–67%) and CPFE (r = 56–59%). CVEs were the presenting symptom in 30 (54.5%) patients. CVE recurrence was high; the 5-year CVE recurrence rate in patients with tumor resection was 24.0% compared to 60.0% without resection. No baseline patient characteristics or tumor features were associated with an initial presentation of CVEs compared to any other indication. Univariate analysis indicated that prolonged duration to surgical resection, left atrial enlargement, male sex, and a neutrophil–lymphocyte ratio >3.0 at the follow-up were significantly associated with 5-year CVE recurrence. Left atrial enlargement and a neutrophil–lymphocyte ratio >3.0 at the follow-up remained significantly associated with 5-year CVE recurrence in multivariate analysis.ConclusionThe neutrophil–lymphocyte ratio may prognosticate tumor size and recurrence of neurologic events. An increased risk of CVE within 5 years of mass resection is almost exclusive to patients initially presenting with CVEs. |
| first_indexed | 2024-03-12T11:26:12Z |
| format | Article |
| id | doaj.art-7a7443d1ca624719bdc64ed930a49a26 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-12T11:26:12Z |
| publishDate | 2023-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-7a7443d1ca624719bdc64ed930a49a262023-09-01T07:43:47ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-09-011010.3389/fcvm.2023.12221791222179Clinical presentation and neurovascular manifestations of cardiac myxomas and papillary fibroelastomas: a retrospective single-institution cohort studyAkshay Mathavan0Akash Mathavan1Urszula Krekora2Mohit Mathavan3Vanessa Rodriguez4Ellery Altshuler5Brianna Nguyen6Mohammed Ruzieh7Department of Internal Medicine, University of Florida, Gainesville, FL, United StatesDepartment of Internal Medicine, University of Florida, Gainesville, FL, United StatesUniversity of Central Florida College of Medicine, University of Central Florida, Orlando, FL, United StatesDepartment of Family Medicine, Ocala Hospital, Ocala, FL, United StatesDepartment of Internal Medicine, University of South Florida, Tampa, FL, United StatesDepartment of Internal Medicine, University of Florida, Gainesville, FL, United StatesUniversity of Florida College of Medicine, University of Florida, Gainesville, FL, United StatesDivision of Cardiovascular Medicine, University of Florida, Gainesville, FL, United StatesBackgroundPrimary cardiac tumors are often benign and commonly present as cardiac myxomas (CMs) or papillary fibroelastomas (CPFEs). There is a paucity of prognostic indicators for tumor burden or potential for embolic cerebrovascular events (CVEs). This study was performed to address these gaps.MethodsMedical records at the University of Florida Health Shands Hospital between 1996 and 2021 were screened to identify patients with CMs or CPFEs. Clinical features, echocardiographic reports, and CVE outcomes were quantitatively assessed.ResultsA total of 55 patients were included in the study: 28 CM (50.9%) and 27 CPFE (49.1%) patients. Baseline patient characteristics were similar among patients. The neutrophil–lymphocyte ratio was correlated (p < 0.005 in all cases) to three metrics of tumor size in both CM (r = 64–67%) and CPFE (r = 56–59%). CVEs were the presenting symptom in 30 (54.5%) patients. CVE recurrence was high; the 5-year CVE recurrence rate in patients with tumor resection was 24.0% compared to 60.0% without resection. No baseline patient characteristics or tumor features were associated with an initial presentation of CVEs compared to any other indication. Univariate analysis indicated that prolonged duration to surgical resection, left atrial enlargement, male sex, and a neutrophil–lymphocyte ratio >3.0 at the follow-up were significantly associated with 5-year CVE recurrence. Left atrial enlargement and a neutrophil–lymphocyte ratio >3.0 at the follow-up remained significantly associated with 5-year CVE recurrence in multivariate analysis.ConclusionThe neutrophil–lymphocyte ratio may prognosticate tumor size and recurrence of neurologic events. An increased risk of CVE within 5 years of mass resection is almost exclusive to patients initially presenting with CVEs.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1222179/fullcardiac myxomascardiac papillary fibroelastomaneutrophil–lymphocyte (N/L ratio)cerebrovascular eventsbenign cardiac neoplasms |
| spellingShingle | Akshay Mathavan Akash Mathavan Urszula Krekora Mohit Mathavan Vanessa Rodriguez Ellery Altshuler Brianna Nguyen Mohammed Ruzieh Clinical presentation and neurovascular manifestations of cardiac myxomas and papillary fibroelastomas: a retrospective single-institution cohort study Frontiers in Cardiovascular Medicine cardiac myxomas cardiac papillary fibroelastoma neutrophil–lymphocyte (N/L ratio) cerebrovascular events benign cardiac neoplasms |
| title | Clinical presentation and neurovascular manifestations of cardiac myxomas and papillary fibroelastomas: a retrospective single-institution cohort study |
| title_full | Clinical presentation and neurovascular manifestations of cardiac myxomas and papillary fibroelastomas: a retrospective single-institution cohort study |
| title_fullStr | Clinical presentation and neurovascular manifestations of cardiac myxomas and papillary fibroelastomas: a retrospective single-institution cohort study |
| title_full_unstemmed | Clinical presentation and neurovascular manifestations of cardiac myxomas and papillary fibroelastomas: a retrospective single-institution cohort study |
| title_short | Clinical presentation and neurovascular manifestations of cardiac myxomas and papillary fibroelastomas: a retrospective single-institution cohort study |
| title_sort | clinical presentation and neurovascular manifestations of cardiac myxomas and papillary fibroelastomas a retrospective single institution cohort study |
| topic | cardiac myxomas cardiac papillary fibroelastoma neutrophil–lymphocyte (N/L ratio) cerebrovascular events benign cardiac neoplasms |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1222179/full |
| work_keys_str_mv | AT akshaymathavan clinicalpresentationandneurovascularmanifestationsofcardiacmyxomasandpapillaryfibroelastomasaretrospectivesingleinstitutioncohortstudy AT akashmathavan clinicalpresentationandneurovascularmanifestationsofcardiacmyxomasandpapillaryfibroelastomasaretrospectivesingleinstitutioncohortstudy AT urszulakrekora clinicalpresentationandneurovascularmanifestationsofcardiacmyxomasandpapillaryfibroelastomasaretrospectivesingleinstitutioncohortstudy AT mohitmathavan clinicalpresentationandneurovascularmanifestationsofcardiacmyxomasandpapillaryfibroelastomasaretrospectivesingleinstitutioncohortstudy AT vanessarodriguez clinicalpresentationandneurovascularmanifestationsofcardiacmyxomasandpapillaryfibroelastomasaretrospectivesingleinstitutioncohortstudy AT elleryaltshuler clinicalpresentationandneurovascularmanifestationsofcardiacmyxomasandpapillaryfibroelastomasaretrospectivesingleinstitutioncohortstudy AT briannanguyen clinicalpresentationandneurovascularmanifestationsofcardiacmyxomasandpapillaryfibroelastomasaretrospectivesingleinstitutioncohortstudy AT mohammedruzieh clinicalpresentationandneurovascularmanifestationsofcardiacmyxomasandpapillaryfibroelastomasaretrospectivesingleinstitutioncohortstudy |