BACKGROUND The incidental detection of a right atrial mass during routine cardioncological workup is a rare condition. The correct differential diagnosis between cancer and thrombi is challenging. A biopsy may not be ...BACKGROUND The incidental detection of a right atrial mass during routine cardioncological workup is a rare condition. The correct differential diagnosis between cancer and thrombi is challenging. A biopsy may not be feasible while diagnostic techniques and tools may not be available.CASE SUMMARY We report the case of a 59-year-old female patient with a history of breast cancer and current secondary metastatic pancreatic cancer. She developed deep vein thrombosis and pulmonary embolism and was admitted to the Outpatient Clinic of our Cardio-Oncology Unit for follow-up. Transthoracic echocardiogram incidentally found a right atrial mass. Clinical management was difficult due to the abrupt worsening of the patient’s clinical condition and the progressive severe thrombocytopenia. We suspected a thrombus, according to its echocardiographic appearance, the patient’s cancer history and recent venous thromboembolism. The patient was unable to adhere to low molecular weight heparin treatment. Due to worsening prognosis, palliative care was recommended. We also highlighted the distinguishing features between thrombi and tumors. We proposed a diagnostic flowchart to aid diagnostic decision making in the case of an incidental atrial mass.CONCLUSION This case report highlights the importance of cardioncological surveillance during anticancer treatments to detect cardiac masses.展开更多
A 66-year-old female with a 1-month history of increasing fatigue, dyspnea on exertion, and palpitations presented with clinical signs of heart failure. Chest computed tomography (CT) revealed a large, mobile left atr...A 66-year-old female with a 1-month history of increasing fatigue, dyspnea on exertion, and palpitations presented with clinical signs of heart failure. Chest computed tomography (CT) revealed a large, mobile left atrial (LA) mass attached to the mitral valve causing severe mitral stenosis and mitral regurgitation. The mass was surgically debulked and the mitral valve was replaced. Pathology revealed a poorly differentiated malignant spindle cell neoplasm with diffuse nuclear positivity of MDM2 and multifocal positivity of CDK4, consistent with intimal sarcoma. This case seeks to describe an uncommon presentation of a rare malignancy, and the surgical and medical management of the disease.展开更多
Background: The influence of obesity on the cardiac geometry is less clear. Our objective was to determine if body mass index (BMI) was an independent predictor of left atrial enlargement (LAE) relative to LV thicknes...Background: The influence of obesity on the cardiac geometry is less clear. Our objective was to determine if body mass index (BMI) was an independent predictor of left atrial enlargement (LAE) relative to LV thickness, dimension and function. Methods: Retrospective analysis of 90 consecutive patients with available echocardiographic data was performed. Patients were categorized into those with LAE (defined as >4.0 cm in transverse dimension by M-mode, n = 36) and those with normal LA size (n = 54). The clinical and echocardiographic variables were compared between the two groups. Results: Compared to patients with normal LA size, patients with LAE had significantly higher BMI (32 ± 8 vsi ± 8, p = 0.006), greater LV thickness, increased LV cavity dimension, and depressed LV systolic function. BMI was a strong and independent predictor of LAE. Left ventricular thickness and LV end-diastolic (LVED) dimension were other independent predictors of LAE. After adjusting for the significant effects of LV thickness and LV diameter, every unit increase in BMI resulted in an 8% increase in the odds of having LAE. Conclusions: 1) Higher BMI is an independent predictor of LAE. 2) Presence of LV enlargement and LV systolic dysfunction in these patients suggests that in the face of higher BMI, cardiac workload may exceed the compensatory LV hypertrophy and 3) LAE may be a consequence of the greater force developed by the LA to fill the LV.展开更多
目的系统评价不同体质指数(BMI)水平对普通人群新发心房颤动(房颤)风险的影响。方法计算机检索Pubmed、CNKI数据库中关于BMI与普通人群新发房颤风险关系的观察性研究,检索时间截止至2016年7月。根据预先设定的文献纳入与排除标准,由2名...目的系统评价不同体质指数(BMI)水平对普通人群新发心房颤动(房颤)风险的影响。方法计算机检索Pubmed、CNKI数据库中关于BMI与普通人群新发房颤风险关系的观察性研究,检索时间截止至2016年7月。根据预先设定的文献纳入与排除标准,由2名评价员独立进行文献筛选、资料提取、质量评价等工作,将符合标准的文献纳入,利用Rev Man 5.3软件进行Meta分析。结果在初步检索得到的685篇文献中,共纳入12篇符合标准的文献。Meta分析结果显示,与正常组相比,超重组的房颤发病风险增加43%(RR=1.43,95%CI:1.30~1.57,P<0.00001),肥胖组的房颤发病风险增加89%(RR=1.89,95%CI:1.69~2.12,P<0.00001);与超重组相比,肥胖组的房颤发病风险增加32%(RR=1.32,95%CI:1.25~1.39,P<0.00001);与非肥胖组相比,肥胖组的房颤发病风险增加55%(RR=1.55,95%CI:1.41~1.69,P<0.00001)。结论超重与肥胖明显增加普通人群新发房颤的风险,随着BMI水平的增加,新发房颤风险也在逐级增加。展开更多
目的:探讨高血压患者动态动脉硬化指数(AASI)、相应对称性动态动脉硬化指数(AASI-BPVR)与左心室质量指数(LVMI)、左心房内径(LAD)的相关性。方法:采用常规24 h动态血压监测数据测定及计算286例高血压病患者AASI、AASI-BPVR以及经超声心...目的:探讨高血压患者动态动脉硬化指数(AASI)、相应对称性动态动脉硬化指数(AASI-BPVR)与左心室质量指数(LVMI)、左心房内径(LAD)的相关性。方法:采用常规24 h动态血压监测数据测定及计算286例高血压病患者AASI、AASI-BPVR以及经超声心动图测定左心室舒张末内径、室间隔厚度、左心室后壁厚度、LAD,计算左心室质量、LVMI、相对室壁厚度,同时检测空腹血糖、血脂水平,进行Pearson相关分析及多元线性回归分析。将24 h AASI>中位数(即>0.51)者为A组(n=133),24 hAASI<中位数(即≤0.51)者为B组(n=153)。结果:A组较B组LVMI增加,差异有统计学意义(P<0.05),左心室质量虽较大,但差异无统计学意义(P=0.384);经Pearson相关分析,LVMI、LAD与各动态动脉硬化指数无明显相关,其中24 h AASI-BPVR与LAD相关系数r=0.111,但差异无统计学意义(P=0.057)。结论:AASI、AASI-BPVR不是高血压左心室肥厚及左心房扩大的独立影响因素,目前尚不能作为高血压心脏损害的预测因子。展开更多
文摘BACKGROUND The incidental detection of a right atrial mass during routine cardioncological workup is a rare condition. The correct differential diagnosis between cancer and thrombi is challenging. A biopsy may not be feasible while diagnostic techniques and tools may not be available.CASE SUMMARY We report the case of a 59-year-old female patient with a history of breast cancer and current secondary metastatic pancreatic cancer. She developed deep vein thrombosis and pulmonary embolism and was admitted to the Outpatient Clinic of our Cardio-Oncology Unit for follow-up. Transthoracic echocardiogram incidentally found a right atrial mass. Clinical management was difficult due to the abrupt worsening of the patient’s clinical condition and the progressive severe thrombocytopenia. We suspected a thrombus, according to its echocardiographic appearance, the patient’s cancer history and recent venous thromboembolism. The patient was unable to adhere to low molecular weight heparin treatment. Due to worsening prognosis, palliative care was recommended. We also highlighted the distinguishing features between thrombi and tumors. We proposed a diagnostic flowchart to aid diagnostic decision making in the case of an incidental atrial mass.CONCLUSION This case report highlights the importance of cardioncological surveillance during anticancer treatments to detect cardiac masses.
文摘A 66-year-old female with a 1-month history of increasing fatigue, dyspnea on exertion, and palpitations presented with clinical signs of heart failure. Chest computed tomography (CT) revealed a large, mobile left atrial (LA) mass attached to the mitral valve causing severe mitral stenosis and mitral regurgitation. The mass was surgically debulked and the mitral valve was replaced. Pathology revealed a poorly differentiated malignant spindle cell neoplasm with diffuse nuclear positivity of MDM2 and multifocal positivity of CDK4, consistent with intimal sarcoma. This case seeks to describe an uncommon presentation of a rare malignancy, and the surgical and medical management of the disease.
文摘Background: The influence of obesity on the cardiac geometry is less clear. Our objective was to determine if body mass index (BMI) was an independent predictor of left atrial enlargement (LAE) relative to LV thickness, dimension and function. Methods: Retrospective analysis of 90 consecutive patients with available echocardiographic data was performed. Patients were categorized into those with LAE (defined as >4.0 cm in transverse dimension by M-mode, n = 36) and those with normal LA size (n = 54). The clinical and echocardiographic variables were compared between the two groups. Results: Compared to patients with normal LA size, patients with LAE had significantly higher BMI (32 ± 8 vsi ± 8, p = 0.006), greater LV thickness, increased LV cavity dimension, and depressed LV systolic function. BMI was a strong and independent predictor of LAE. Left ventricular thickness and LV end-diastolic (LVED) dimension were other independent predictors of LAE. After adjusting for the significant effects of LV thickness and LV diameter, every unit increase in BMI resulted in an 8% increase in the odds of having LAE. Conclusions: 1) Higher BMI is an independent predictor of LAE. 2) Presence of LV enlargement and LV systolic dysfunction in these patients suggests that in the face of higher BMI, cardiac workload may exceed the compensatory LV hypertrophy and 3) LAE may be a consequence of the greater force developed by the LA to fill the LV.
文摘目的系统评价不同体质指数(BMI)水平对普通人群新发心房颤动(房颤)风险的影响。方法计算机检索Pubmed、CNKI数据库中关于BMI与普通人群新发房颤风险关系的观察性研究,检索时间截止至2016年7月。根据预先设定的文献纳入与排除标准,由2名评价员独立进行文献筛选、资料提取、质量评价等工作,将符合标准的文献纳入,利用Rev Man 5.3软件进行Meta分析。结果在初步检索得到的685篇文献中,共纳入12篇符合标准的文献。Meta分析结果显示,与正常组相比,超重组的房颤发病风险增加43%(RR=1.43,95%CI:1.30~1.57,P<0.00001),肥胖组的房颤发病风险增加89%(RR=1.89,95%CI:1.69~2.12,P<0.00001);与超重组相比,肥胖组的房颤发病风险增加32%(RR=1.32,95%CI:1.25~1.39,P<0.00001);与非肥胖组相比,肥胖组的房颤发病风险增加55%(RR=1.55,95%CI:1.41~1.69,P<0.00001)。结论超重与肥胖明显增加普通人群新发房颤的风险,随着BMI水平的增加,新发房颤风险也在逐级增加。
文摘目的:探讨高血压患者动态动脉硬化指数(AASI)、相应对称性动态动脉硬化指数(AASI-BPVR)与左心室质量指数(LVMI)、左心房内径(LAD)的相关性。方法:采用常规24 h动态血压监测数据测定及计算286例高血压病患者AASI、AASI-BPVR以及经超声心动图测定左心室舒张末内径、室间隔厚度、左心室后壁厚度、LAD,计算左心室质量、LVMI、相对室壁厚度,同时检测空腹血糖、血脂水平,进行Pearson相关分析及多元线性回归分析。将24 h AASI>中位数(即>0.51)者为A组(n=133),24 hAASI<中位数(即≤0.51)者为B组(n=153)。结果:A组较B组LVMI增加,差异有统计学意义(P<0.05),左心室质量虽较大,但差异无统计学意义(P=0.384);经Pearson相关分析,LVMI、LAD与各动态动脉硬化指数无明显相关,其中24 h AASI-BPVR与LAD相关系数r=0.111,但差异无统计学意义(P=0.057)。结论:AASI、AASI-BPVR不是高血压左心室肥厚及左心房扩大的独立影响因素,目前尚不能作为高血压心脏损害的预测因子。
