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

• Published in: Journal of cardiovascular magnetic resonance Vol. 19; no. 1; p. 76
• Main Authors: Chan, Angel T, Plodkowski, Andrew J, Pun, Shawn C, Lakhman, Yuliya, Halpenny, Darragh F, Kim, Jiwon, Goldburg, Samantha R, Matasar, Mathew J, Moskowitz, Chaya S, Gupta, Dipti, Steingart, Richard, Weinsaft, Jonathan W
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12-10-2017; BioMed Central; Elsevier
• Subjects: Angiogenesis; Apoptosis; Atrium; Blood clots; Breast cancer; Cancer; Cancer therapies; Cardiac mass; Cardiac metastases; Cardiac thrombus; Cardio-oncology; Cardiovascular disease; Care and treatment; Catheters; Contrast Media; Control methods; Coronary Thrombosis - diagnostic imaging; Diagnosis; Diagnosis, Differential; Diagnostic systems; Disease control; Etiology; Etiology (Medicine); Female; Gadolinium; Gangrene; Health risks; Heart; Heart attacks; Heart Neoplasms - diagnostic imaging; Humans; Hypoxia; Image Enhancement - methods; Lesions; Localization; Lung cancer; Lymphoma; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical prognosis; Metastasis; Middle Aged; Mortality; Neoplasia; Neoplasms; Noise; Organs; Patients; Population studies; Prognosis; Reproducibility of Results; Resonance; Risk management; Sarcoma; Structure-function relationships; Thrombosis; Tissues; Tumors; Ventricle; Cardiac metastases; Cardio-oncology; Cardiac mass; Cardiac thrombus
• ISSN: 1097-6647; 1532-429X
• DOI: 10.1186/s12968-017-0390-2

Late gadolinium enhancement (LGE-) cardiovascular magnetic resonance (CMR) is well-validated for cardiac mass (C
) tissue characterization to differentiate neoplasm (C
) from thrombus (C
): Prognostic implications of C
subtypes among systemic cancer patients are unknown.
C
 + patients and controls (C
-) matched for cancer diagnosis and stage underwent a standardized CMR protocol, including LGE-CMR (IR-GRE) for tissue characterization and balanced steady state free precession cine-CMR (SSFP) for cardiac structure/function. C
subtypes (C
, C
) were respectively defined by presence or absence of enhancement on LGE-CMR; lesions were quantified for tissue properties (contrast-to-noise ratio (CNR); signal-to-noise ratio (SNR) and size. Clinical follow-up was performed to evaluate prognosis in relation to C
etiology.
The study population comprised 126 patients with systemic neoplasms referred for CMR, of whom 50% (n = 63) had C
+ (C
 = 32%, C
 = 18%). Cancer etiology differed between C
(sarcoma = 20%, lung = 18%) and C
(lymphoma = 30%, GI = 26%); cardiac function (left ventricular ejection fraction: 63 ± 9 vs. 62 ± 10%; p = 0.51∣ right ventricular ejection fraction: 53 ± 9 vs. 54 ± 8%; p = 0.47) and geometric indices were similar (all p = NS). LGE-CMR tissue properties assessed by CNR (13.1 ± 13.0 vs. 1.6 ± 1.0; p < 0.001) and SNR (29.7 ± 20.4 vs. 15.0 ± 11.4, p = 0.003) were higher for C
, consistent with visually-assigned diagnostic categories. C
were more likely to localize to the right atrium (78% vs. 25%, p < 0.001); nearly all (17/18) were associated with central catheters. Lesion size (17.3 ± 23.8 vs. 2.0 ± 1.5 cm
; p < 0.001) was greater with C
vs. C
, as was systemic disease burden (cancer-involved organs: 3.6 ± 2.0 vs. 2.3 ± 2.1; p = 0.02). Mortality during a median follow-up of 2.5 years was markedly higher among patients with C
compared to those with C
(HR = 3.13 [CI 1.54-6.39], p = 0.002); prognosis was similar when patients were stratified by lesion size assessed via area (HR = 0.99 per cm
[CI 0.98-1.01], p = 0.40) or maximal diameter (HR = 0.98 per cm [CI 0.91-1.06], p = 0.61). C
conferred similar mortality risk compared to cancer-matched controls without cardiac involvement (p = 0.64) whereas mortality associated with C
was slightly higher albeit non-significant (p = 0.12).
Among a broad cancer cohort with cardiac masses, C
defined by LGE-CMR tissue characterization conferred markedly poorer prognosis than C
, whereas anatomic assessment via cine-CMR did not stratify mortality risk. Both C
and C
are associated with similar prognosis compared to C
- controls matched for cancer type and disease extent.