背景:心脏肿块代表了一种异质性的临床情景。恶性肿瘤的潜在心电图危险信号仍有待研究。
目的:描述大量心脏肿块中心电图异常的频谱,并评估提示恶性肿瘤的潜在危险信号。
方法:在博洛尼亚大学医院对322名连续的心脏质量和心电图患者进行的观察性队列研究。所有肿块都是通过组织学检查确诊的,在心脏血栓的情况下,通过适当抗凝治疗后的放射学分辨率。多变量回归分析用于评估心电图异常中恶性肿瘤的潜在预测因子。评估随访时的全因死亡率。
结果:在322名患者中,恶性肿瘤98例(30.4%)。与良性肿块患者相比,那些患有恶性肿瘤的人表现出更高的心率,右轴偏差,更大的去极化,复极异常和缓慢性心律失常。关于特定的ECG特征,入院时心率较高(p=0.014),缓慢性心律失常(p=0.009),缺血样复极化异常(ST段偏离,凹陷和抬高,和负T波;p<0.001),低电压(p=0.001)和右轴偏离(0.025)被确定为恶性肿瘤的独立预测因子.考虑到这些特定的心电图改变,在随访时,以恶性肿瘤为导向的心电图与较高的死亡率相关(中位时间为20.7个月).
结论:在心脏恶性肿瘤的情况下,心电图通常是异常的。一些特定的心电图改变强烈提示恶性肿瘤和浸润类型。
BACKGROUND: Cardiac masses represent a heterogeneous clinical scenario. Potential electrocardiographic (ECG) red flags of malignancy remain to be investigated.
OBJECTIVE: The purpose of this study was to describe the spectrum of ECG abnormalities in a large cohort of cardiac masses and to evaluate potential red flags suggestive of malignancy.
METHODS: This was an observational cohort study of 322 consecutive patients with a cardiac mass and available ECG at Bologna University Hospital. All masses were diagnosed by histologic examination or, in the case of cardiac thrombi, by radiologic resolution after proper anticoagulant therapy. Multivariable regression analysis was used to assess potential predictors of malignancy among ECG abnormalities. All-cause mortality at follow-up was evaluated.
RESULTS: Of 322 patients, 98 (30.4%) had malignant tumors. Compared with patients with benign masses, those with malignant tumors exhibited a higher heart rate, right-axis deviation, greater depolarization, repolarization abnormalities, and bradyarrhythmia at presentation. Regarding specific ECG features, a higher heart rate on admission (P = .014), bradyarrhythmias (P = .009), ischemic-like repolarization abnormalities (ST-segment deviation, both depression and elevation, and negative T-wave; P <.001), low voltages (P = .001), and right-axis deviation (P = .025) were identified as independent predictors of malignancy. Considering these specific ECG alterations, a malignancy-oriented ECG was associated with higher mortality at follow-up (median 20.7 months).
CONCLUSIONS: ECG frequently is abnormal in cases of malignant cardiac tumors. Some specific ECG changes are strongly suggestive for malignancy and type of infiltration.