Prognostic prediction of troponins in cardiac myxoma: case study with literature review

Abstract

ObjectiveIt was supposed that troponins in cardiac myxoma patients might be in a same fashion as in the conditions without myocardial injury. In order to verify this hypothesis, troponins in cardiac myxoma patients were discussed by presenting a comprehensive retrieval of the literature with incorporating the information of a recent patient.MethodsPostoperative detections of troponin I, creatine kinase isoenzyme MB (CK-MB) and N-terminal pro-B-type natriuretic peptide revealed elevated troponin I and CK-MB and normal N-terminal pro-B-type natriuretic peptide. Postoperative troponin I and CK-MB shared a same trend, reaching a peak value at postoperative hour 2, gradually decreased on postoperative day 1, and reached a plateau on postoperative days 7 and 13. A significant correlation could be noted between the postoperative values of the two indicators (Y=0.0714X + 0.6425, r2=0.9111, r=0.9545, P=0.0116). No significant linear correlation between troponin I and N-terminal pro-B-type natriuretic peptide were found. Literature review of troponins in cardiac myxoma patients revealed the uncomplicated patients had a normal or only slightly elevated troponin before open heart surgery. However, the complicated patients (with cerebral or cardiac events) showed a normal preoperative troponin in 3 (23.1%) and an elevated troponin in 10 (76.9%) patients (χ2=7.54, P=0.0169, Fisher's exact test). The overall quantitative result of troponin I was 2.45±2.53 µg/L, and that of troponin T was 3.10±4.29 mg/L, respectively.ConclusionTroponins are not necessarily elevated in patients with a cardiac myxoma without coronary syndrome. By contrast, patients with a cardiac myxoma with an elevated troponin may herald the presence of an associated coronary event. An old cerebral infarct does not necessarily cause an elevation of troponin or B-type natriuretic peptide, or new neurological events, but might lead to a delayed awakening.

Stroke of a cardiac myxoma origin

“…Nineteen (14.3%) patients had other than cerebral artery embolisms, with systemic multiple emboli in 4 (21.1%) [ 55 , 63 , 71 , 80 ] , peripheral multiple emboli in 3 (15.8%) [ 19 , 72 , 85 ] and solitary arterial embolus in 12 (63.2%) patients [ 9 , 11 , 13 , 16 , 21 , 35 , 41 , 43 , 60 , 76 , 84 ] . The 39 affected arteries in 18 patients were listed in Table 8 .…”

“…Lee et al [ 45 ] reported 13 of 59 (22.0%) patients with a cardiac myxoma developed embolic events, 11 (18.6%) of which were in the brain, 2 (3.4%) in the limb and 1 (1.7%) in the eye. Furthermore, Yuan [ 85 ] reported a patient with a delayed cardiac myxoma resection developed multiple embolic events in the lower extremities. Bajraktari et al [ 16 ] reported one cardiac myxoma patient who declined to all treatments for 7 years eventually developed mesenteric embolism.…”

Unusual aspects of cardiac myxoma

“…In addition, the miscellaneous and uncharacteristic clinical manifestations of a cardiac myxoma vary considerably on a case-to-case basis. This peculiarity of the presenting symptoms often leads to delayed presentation and a delayed diagnosis, eventually resulting in unexpected poor prognosis ( 5 ). Therefore, a comprehensive understanding of the usual aspects of cardiac myxomas is extremely important for an early diagnosis and prompt treatment.…”

Cardiac myxoma presenting with fever of unknown origin

“…In particular, 26.9% patients of this cohort presenting with only constitutional symptoms make the diagnosis quite difficult. Hence, the rapidity of the diagnosis in the patients with a cardiac myxoma presenting as FUO determines the patients' outcomes [8]. In order to disclose the mysterious nature of this condition, it is important to always recall it, to employ an echocardiographic screening and lead to the curative treatment of surgical resection [9].…”