Pattern and Prognostic Implications of Cardiac Metastases Among Patients With Advanced Systemic Cancer Assessed With Cardiac Magnetic Resonance Imaging

Abstract

BackgroundCardiac magnetic resonance (CMR) imaging is well validated for tissue characterization of cardiac masses but has not been applied to study pattern and prognostic implications of cardiac metastases (CMETs) among patients with systemic cancer.Methods and ResultsThe population consisted of 60 patients with stage IV cancer (32 patients with CMETs, 28 diagnosis‐matched controls) undergoing CMR. CMET was defined as a discrete mass with vascular tissue properties on delayed enhancement CMR. CMET‐positive patients and controls had similar clinical characteristics, cardiac geometry, and function (P=NS). Leading cancer types associated with CMET were sarcoma, melanoma, and gastrointestinal. Patients with CMETs had similar distribution of extracardiac metastatic disease compared with controls (organs involved: 3.4±2.0 versus 2.7±1.9, P=0.17). In 94% of patients with CMETs, there were metastases involving ≥1 extracardiac organ (66% lung involvement). CMET location varied (right ventricle 44%, right atrium 19%, left ventricle 28%, left atrium 9%, pericardial 25%); 22% of cases had multichamber involvement. Right‐sided chamber involvement was common in hematologic/lymphatic spread (67%); pericardial involvement was common with direct spread (64%). Regarding tissue properties on delayed enhancement CMR, CMETs commonly (59%) demonstrated heterogeneous enhancement (41% diffuse enhancement). Heterogeneous lesions were larger and had increased border irregularity (P<0.05). Survival 6 months post‐CMR was numerically lower among patients with CMETs (56% [95% CI 39–74%]) versus stage IV cancer–matched controls (68% [95% CI 50–86%]), although differences between groups were nonsignificant (P=0.42).Conclusions CMETs vary regarding etiology, location, and tissue properties on CMR, highlighting need for comprehensive surveillance of cardiac involvement regardless of cancer origin. Prognosis remains poor with for patients with CMETs, albeit similar to that for stage IV cancer controls matched for cancer etiology.

Prognostic utility of differential tissue characterization of cardiac neoplasm and thrombus via late gadolinium enhancement cardiovascular magnetic resonance among patients with advanced systemic cancer

“…leukemia) as well as primary cardiac malignancies were excluded. Established criteria [ 3 , 7 – 9 ] were used to distinguish C MASS subtypes: (1) Neoplasm (C NEO ) was defined as C MASS with evidence of vascularity on LGE-CMR, defined by heterogeneous or diffuse contrast enhancement. (2) Thrombus (C THR ) was defined as C MASS without contrast enhancement.…”

“…In all patients, comprehensive clinical data were collected in a standardized manner, including cancer etiology, coronary heart disease risk factors, and anti-cancer therapies administered within 6 months of CMR. C MASS data (imaging and clinical assessment) was collected as part of an ongoing registry of patients undergoing clinically indicated CMR, for which initial results (limited to C NEO patients) have been partially reported [ 3 ]. CMR was performed between September 2012 and January 2017 at Memorial Sloan Kettering Cancer Center (New York, New York, USA).…”

“…Prior research by our group and others has validated LGE-CMR as a highly accurate test for thrombus among non-cancer cohorts, including post-myocardial infarction and heart failure patients in whom LGE-CMR evidenced left ventricular (LV) thrombus has been shown to correlate with histopathology findings, and yield incremental utility (compared to anatomic imaging) for stratification of thrombo-embolic events [ 6 – 9 ]. More recently, we have employed LGE-CMR tissue characterization to identify C NEO among patients with advanced systemic cancer, among whom prognosis paralleled cancer etiology and systemic disease burden [ 3 ]. However, prior research to date has been limited to patient cohorts with either C NEO or C THR , thereby prohibiting comparison of risk factors and differential prognosis associated with each of these two conditions.…”

Pericardial Masses, Cysts and Diverticula: A Comprehensive Review Using Multimodality Imaging

“…[37][38][39] The most common site of metastatic involvement of the heart is the pericardium, 9 and in a series of patients with known intracardiac metastases 25% had additional pericardial metastases. 40 The most common sources of metastatic disease to the pericardium are lung and breast carcinoma, melanoma and leukemia/lymphoma though other malignancies including esophageal carcinoma and sarcoma are known to have cardiac involvement as well. 9,36,38,39 Tumors may spread to the pericardium via a hematogenous or lymphatic route, or direct invasion from the lung or mediastinum.…”

“…10 Series evaluating cardiac tumors, either primary or metastatic, have been conducted in small diverse samples showing variable patterns with gadolinium contrast administration ranging from heterogenous to diffuse uptake. 22,40,[56][57][58] Heterogenous gadolinium uptake has been correlated with increased lesion nodularity and has been hypothesized to represent areas of tumor necrosis and rapid growth.…”