Systematic Review and Meta-analysis of Prevalence of Coronary Artery Disease in Adult Patients with Cardiac Myxomas

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Abstract

Background: Studies have reported varied prevalence estimates of coronary artery disease (CAD) in cardiac myxoma patients. We performed a systematic review and meta-analysis of observational studies to summarize the point prevalence of CAD in adults with cardiac myxomas.

Methods and Results: Two independent investigators searched MEDLINE and LILACS databases using the terms " Myxoma”, " Coronary Angiography" and " Coronary Disease" from inception through December 2014 for all relevant studies. We included 6 observational studies. Publication bias was evaluated through Egger's test and Trim and Fill method. A pooled estimate of CAD prevalence with corresponding 95% confidence interval (CI) was calculated based on a random-effects model. The pooled CAD prevalence in adult cardiac myxoma patients was 20.7% with low heterogeneity (I ² = 14.86%).

Conclusions: It is a matter of debate if preoperative coronary angiography must be done as a routine procedure. Although coronary disease and angiographically detectable neovascularity can alter surgical management, more studies are needed to evaluate this question.

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Most cited references 26

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Introduction to Meta-Analysis

Michael T. Borenstein, Larry Hedges, Julian P. T. Higgins … (2009)

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Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases.

P Duhaut, L Pinede, R Loire (2001)

We analyzed a series of 112 consecutive cases of left atrial myxoma diagnosed in a single French hospital (72 women and 40 men; age range, 5-84 yr) over 40 years, from 1959 to 1998. Symptoms of mitral valve obstruction, the first arm of the classic triad of myxoma presentation, were present in 75 patients (67%), with mostly cardiac failure or malaise. Symptoms of embolism, the second frequent presentation in the classic triad, were observed in 33 cases (29%) with 1 or several locations, essentially cerebral emboli with stroke. Males are statistically at greater risk than females of developing embolic complications. The third arm of the classic triad consists of constitutional symptoms (34%) with fever, weight loss, or symptoms resembling connective tissue disease, due to cytokine (interleukin-6) secretion. Younger and male patients have more neurologic symptoms, and female patients have more systemic symptoms. Seventy-two patients (64%) had cardiac auscultation abnormalities, essentially pseudo-mitral valve disease (53.5%) and more rarely the suggestive tumor plop (15%). The most frequent electrocardiographic sign was left atrial hypertrophy (35%), whereas arrhythmias were uncommon. The greater number of myxoma patients (98) diagnosed preoperatively after 1977 reflects the introduction of echocardiography as a noninvasive diagnostic procedure. However, there was no significant reduction in the average time from onset of symptoms to operation between patients seen in the periods before and after 1977. The tumor diameter ranged from 1 to 15 cm with a weight of between 15 and 180 g (mean, 37 g). The myxoma surface was friable or villous in 35% of the cases, and smooth in the other 65% cases. Myxomas in patients presenting with embolism have a friable surface; those in patients with cardiac symptoms, pseudo-mitral auscultation signs, tumor plop, and electrocardiogram or radiologic signs of left atrium hypertrophy and dilatation are significantly the larger tumors. The long-term prognosis is excellent, and only 4 deaths occurred among our 112 cases over a median follow-up of 3 years. The recurrence rate is low (5%), but long-term follow-up and serial echocardiography are advisable especially for young patients.

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Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies.

K Y Lam, P Dickens, A Chan (1993)

Cardiac involvement by primary and secondary tumors is one of the least investigated subjects in oncology. Seven cases of primary and 154 cases of secondary cardiac tumors from autopsies performed over a 20-year period (1972 through 1991) at Queen Mary Hospital, Hong Kong, were reviewed. During this period, 12,485 autopsies were performed, and the autopsy incidence for primary and secondary heart tumors is thus 0.056% and 1.23%, respectively. Only seven primary cardiac tumors were found, including two myxomas, two rhabdomyomas, two hemangiomas, and one lipoma. For secondary tumors involving the heart (including both metastasis and local extension), important primary tumors in male subjects were carcinoma of the lung (31.7%), esophageal carcinoma (28.7%), lymphoma (11.9%), carcinoma of the liver (6.9%), leukemia (4.0%), and gastric carcinoma (4.0%), while in female subjects, carcinoma of the lung (35.9%), lymphoma (17.0%), carcinoma of the breast (7.5%), and pancreatic carcinoma (7.5%) predominated. Overall, the three most common malignant neoplasms encountered were carcinoma of the lung, esophageal carcinoma, and lymphoma. Pericardium, including epicardium, was the most common location of cardiac involvement by secondary tumors, followed by myocardium and endocardium. The present study showed a higher percentage of esophageal carcinoma and carcinoma of the liver (reflecting the higher incidence of these tumors in Hong Kong Chinese), but a lower incidence of carcinoma of the breast when compared with other series. The metastatic lung tumors showed an unusual predominance of adenocarcinoma.

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Journal

Journal ID (nlm-ta): F1000Res

Journal ID (iso-abbrev): F1000Res

Journal ID (pmc): F1000Research

Title: F1000Research

Publisher: F1000Research (London, UK )

ISSN (Electronic): 2046-1402

Publication date (Electronic): 7 July 2015

Publication date Collection: 2015

Volume: 4

Electronic Location Identifier: 194

Affiliations

[1 ]Inteventional Cardiology Department, Hospital Universitário Ciências Médicas, Belo Horizonte, 30140-073, Brazil

[2 ]Inteventional Cardiology Department, Hospital São José do Avaí, Itaperuna, 28300-000, Brazil

[3 ]Post Graduation Program in Adult Health Sciences and Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

[1 ]Department of Medical Statistics, University Medical Center Göttingen (UMG), Göttingen, Germany

[1 ]Cancer Research UK Stem Cell Biology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK

Author notes

[a ] matheus@ 123456me.com

MCS co-conceived the study, participated in the design of the study, search strategy execution, performance of the statistical analysis, and writing the manuscript.

MSC participated in the search strategy execution, performance of the statistical analysis, and writing the manuscript.

JTN participated in the acquisition of data, performance of the statistical analysis, and writing the manuscript.

ACBS participated in the acquisition of data, performance of the statistical analysis, and writing the manuscript.

MRS co-conceived the study, participated in the design of the study, search strategy execution, performance of the statistical analysis, and writing the manuscript.

Competing interests: No competing interests were disclosed.

Article

DOI: 10.12688/f1000research.6641.1

PMC ID: 5461895

PubMed ID: 28620449

SO-VID: 1f5426a5-761e-4474-9299-40c4784ffa20

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This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Systematic Review and Meta-analysis of Prevalence of Coronary Artery Disease in Adult Patients with Cardiac Myxomas

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Cardiovascular Innovations and Applications

Most cited references 26

Introduction to Meta-Analysis

Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases.

Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies.

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