Echocardiographic findings in cancer-associated non-bacterial thrombotic endocarditis. Clinical series of 111 patients from single institution

Reto D Kurmann; Kyle W Klarich; Ewa Wysokinska; Damon Houghton; Alicja Kaminska; Patryk Patrzalek; David Hodge; Waldemar E Wysokinski

doi:10.1093/ehjci/jeae112

Echocardiographic findings in cancer-associated non-bacterial thrombotic endocarditis. Clinical series of 111 patients from single institution

Eur Heart J Cardiovasc Imaging. 2024 Apr 25:jeae112. doi: 10.1093/ehjci/jeae112. Online ahead of print.

Authors

Reto D Kurmann¹, Kyle W Klarich¹, Ewa Wysokinska², Damon Houghton¹, Alicja Kaminska², Patryk Patrzalek¹, David Hodge³, Waldemar E Wysokinski¹

Affiliations

¹ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
² Hematology/Oncology, Mayo Clinic, Jacksonville, FL.
³ Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL.

PMID: 38662461
DOI: 10.1093/ehjci/jeae112

Abstract

Aims: Echocardiographic assessment of cancer-associated non-bacterial thrombotic endocarditis (Ca-NBTE) is limited to cases reports and small clinical series. Identifying heart valves abnormalities and its relation to embolic complications and cancer types.

Methods and results: Manual review of echocardiographic images and medical records of Mayo Clinic patients (03/31/2002-06/30/2022) was performed. Ca-NBTE in 111 patients (mean age 63.2±9.7 years, 66.7% female) predominantly affected mitral valves (MV) (69), 56 aortic (AV), 8 tricuspid (TV) and rarely pulmonic (PV) (1). In 18 patients 2 valves were involved, 3 and 4 valves involvement in only a single patient each. Embolic complications were prevalent (n=102, 91.9%). Ca-NBTE affected MV more frequently the on upstream (atrial) (90% vs 49.3%) and TV downstream (ventricular) side (75% vs 37.5%). NBTE size (cm) varied significantly among valves, with TV hosting the largest masses (0.63-2.40 x 0.39-1.77), compared to MV [(0.11-1.81 x 0.11-1.62), (length p=0.001; width p=0.03)], and to AV [(0.20-2.70 x 0.11-1.51), (length p=0.001; width p=0.056)]; MV masses were borderline longer in systemic compared to cerebral emboli (p=0.057). Majority of MV (79.6%) and AV (69.6%) had thickened leaflets. NBTE lesions commonly affected closing margins (73.9%MV, 85.7% AV, and 62.5% of TV), but rarely commissures of MV (8.7%), yet fairly frequently of AV (41.1%). Five patients had severe regurgitation of MV and 5 AV.

Conclusion: Ca-NBTE manifests mainly as thrombotic mobile masses attached to thickened MV and AV, with distinct variations in size based on valve type. Embolic destination but not cancer type is associated with NBTE mass size, and location.

Keywords: cancer; cardioembolism; non-bacterial thrombotic endocarditis.

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