Embolic potential of cardiac tumors and outcome after resection: A case-control study

Andrew W. Elbardissi, Joseph A. Dearani, Richard C. Daly, Charles J. Mullany, Thomas A. Orszulak, Francisco J. Puga, Hartzell V Schaff

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND PURPOSE: Embolic events have long been thought to occur in patients with cardiac tumors secondary to embolization of tumor fragments; however, there are no large studies examining the epidemiology and occurrence of embolism in this group of patients. METHODS: From 1957 to 2006, 323 consecutive patients with primary cardiac tumors were treated surgically at our institution. Of these, patients who experienced an embolic event included 80 (cerebrovascular accident 31 [9.7%], transient ischemic attack 30 [9.3%], and other 19 [6%]). Those with no history of an embolic event (n≤243 [75%]) were defined as control subjects. RESULTS: Age was similar between the case and control groups (mean 54.5 versus 53.9 years, P≤0.8). A multivariate logistic regression model including tumor location, tumor burden, tumor histology, and cerebrovascular risk factors, indicated that left atrial tumors (OR, 1.95; P≤0.04), aortic valve tumors (OR, 4.17; P≤0.002), and smaller tumor burden (OR, 2.20; P≤0.01) were the most significant factors in the occurrence of embolism (P<0.001). The presence of mitral regurgitation (OR, 0.12; P≤0.006) and decreased functional status (New York Heart Association III/IV; OR, 0.31; P<0.001) were protective against the occurrence of embolism. Follow-up was obtained in 82% at a mean follow-up time of 6.17±6.9 years. There were no recurrent embolic events at follow-up. A Kaplan-Meier survival curve demonstrated no difference in survival between both groups (P≤0.78). CONCLUSION: Aortic valve and left atrial tumors have the greatest anatomic risk for embolism. Furthermore, patients with smaller tumors, minimal symptomatology, and no evidence of mitral regurgitation have a high risk of embolism. Cardiac tumors can be resected with low early mortality, and late survival after operation in the context of an embolic event is similar to patients with cardiac tumors who undergo resection for other indications.

Original languageEnglish (US)
Pages (from-to)156-162
Number of pages7
JournalStroke
Volume40
Issue number1
DOIs
StatePublished - Jan 1 2009

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Heart Neoplasms
Case-Control Studies
Embolism
Neoplasms
Mitral Valve Insufficiency
Tumor Burden
Aortic Valve
Logistic Models
Survival
Transient Ischemic Attack
Kaplan-Meier Estimate
Histology
Epidemiology
Stroke
Control Groups
Mortality

Keywords

  • Cardiac tumor
  • Embolism
  • Stroke
  • TIA

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing
  • Medicine(all)

Cite this

Elbardissi, A. W., Dearani, J. A., Daly, R. C., Mullany, C. J., Orszulak, T. A., Puga, F. J., & Schaff, H. V. (2009). Embolic potential of cardiac tumors and outcome after resection: A case-control study. Stroke, 40(1), 156-162. https://doi.org/10.1161/STROKEAHA.108.525709

Embolic potential of cardiac tumors and outcome after resection : A case-control study. / Elbardissi, Andrew W.; Dearani, Joseph A.; Daly, Richard C.; Mullany, Charles J.; Orszulak, Thomas A.; Puga, Francisco J.; Schaff, Hartzell V.

In: Stroke, Vol. 40, No. 1, 01.01.2009, p. 156-162.

Research output: Contribution to journalArticle

Elbardissi, AW, Dearani, JA, Daly, RC, Mullany, CJ, Orszulak, TA, Puga, FJ & Schaff, HV 2009, 'Embolic potential of cardiac tumors and outcome after resection: A case-control study', Stroke, vol. 40, no. 1, pp. 156-162. https://doi.org/10.1161/STROKEAHA.108.525709
Elbardissi AW, Dearani JA, Daly RC, Mullany CJ, Orszulak TA, Puga FJ et al. Embolic potential of cardiac tumors and outcome after resection: A case-control study. Stroke. 2009 Jan 1;40(1):156-162. https://doi.org/10.1161/STROKEAHA.108.525709
Elbardissi, Andrew W. ; Dearani, Joseph A. ; Daly, Richard C. ; Mullany, Charles J. ; Orszulak, Thomas A. ; Puga, Francisco J. ; Schaff, Hartzell V. / Embolic potential of cardiac tumors and outcome after resection : A case-control study. In: Stroke. 2009 ; Vol. 40, No. 1. pp. 156-162.
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abstract = "BACKGROUND AND PURPOSE: Embolic events have long been thought to occur in patients with cardiac tumors secondary to embolization of tumor fragments; however, there are no large studies examining the epidemiology and occurrence of embolism in this group of patients. METHODS: From 1957 to 2006, 323 consecutive patients with primary cardiac tumors were treated surgically at our institution. Of these, patients who experienced an embolic event included 80 (cerebrovascular accident 31 [9.7{\%}], transient ischemic attack 30 [9.3{\%}], and other 19 [6{\%}]). Those with no history of an embolic event (n≤243 [75{\%}]) were defined as control subjects. RESULTS: Age was similar between the case and control groups (mean 54.5 versus 53.9 years, P≤0.8). A multivariate logistic regression model including tumor location, tumor burden, tumor histology, and cerebrovascular risk factors, indicated that left atrial tumors (OR, 1.95; P≤0.04), aortic valve tumors (OR, 4.17; P≤0.002), and smaller tumor burden (OR, 2.20; P≤0.01) were the most significant factors in the occurrence of embolism (P<0.001). The presence of mitral regurgitation (OR, 0.12; P≤0.006) and decreased functional status (New York Heart Association III/IV; OR, 0.31; P<0.001) were protective against the occurrence of embolism. Follow-up was obtained in 82{\%} at a mean follow-up time of 6.17±6.9 years. There were no recurrent embolic events at follow-up. A Kaplan-Meier survival curve demonstrated no difference in survival between both groups (P≤0.78). CONCLUSION: Aortic valve and left atrial tumors have the greatest anatomic risk for embolism. Furthermore, patients with smaller tumors, minimal symptomatology, and no evidence of mitral regurgitation have a high risk of embolism. Cardiac tumors can be resected with low early mortality, and late survival after operation in the context of an embolic event is similar to patients with cardiac tumors who undergo resection for other indications.",
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AU - Elbardissi, Andrew W.

AU - Dearani, Joseph A.

AU - Daly, Richard C.

AU - Mullany, Charles J.

AU - Orszulak, Thomas A.

AU - Puga, Francisco J.

AU - Schaff, Hartzell V

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N2 - BACKGROUND AND PURPOSE: Embolic events have long been thought to occur in patients with cardiac tumors secondary to embolization of tumor fragments; however, there are no large studies examining the epidemiology and occurrence of embolism in this group of patients. METHODS: From 1957 to 2006, 323 consecutive patients with primary cardiac tumors were treated surgically at our institution. Of these, patients who experienced an embolic event included 80 (cerebrovascular accident 31 [9.7%], transient ischemic attack 30 [9.3%], and other 19 [6%]). Those with no history of an embolic event (n≤243 [75%]) were defined as control subjects. RESULTS: Age was similar between the case and control groups (mean 54.5 versus 53.9 years, P≤0.8). A multivariate logistic regression model including tumor location, tumor burden, tumor histology, and cerebrovascular risk factors, indicated that left atrial tumors (OR, 1.95; P≤0.04), aortic valve tumors (OR, 4.17; P≤0.002), and smaller tumor burden (OR, 2.20; P≤0.01) were the most significant factors in the occurrence of embolism (P<0.001). The presence of mitral regurgitation (OR, 0.12; P≤0.006) and decreased functional status (New York Heart Association III/IV; OR, 0.31; P<0.001) were protective against the occurrence of embolism. Follow-up was obtained in 82% at a mean follow-up time of 6.17±6.9 years. There were no recurrent embolic events at follow-up. A Kaplan-Meier survival curve demonstrated no difference in survival between both groups (P≤0.78). CONCLUSION: Aortic valve and left atrial tumors have the greatest anatomic risk for embolism. Furthermore, patients with smaller tumors, minimal symptomatology, and no evidence of mitral regurgitation have a high risk of embolism. Cardiac tumors can be resected with low early mortality, and late survival after operation in the context of an embolic event is similar to patients with cardiac tumors who undergo resection for other indications.

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