Abstract
BackgroundThe risk factors contributing to embolism in cardiac myxoma (CM) are yet controversial. This systematic review and meta-analysis aimed to clarify the risk factors of embolism for the CM patients.MethodsPubMed, Embase, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wan Fang, and Wei Pu databases were searched from inception to June 2019. Statistical analysis was conducted using Stata version 14.0. The pooled odds ratio or mean difference with 95% confidence interval was estimated for each risk factor.ResultsHerein, 12 studies, encompassing 1814 patients, were included. The pooled results suggested that New York Heart Association (NYHA) class I/II (P < 0.01), hypertension (P = 0.03), irregular tumor surface (P < 0.01), tumor in atypical location (P = 0.01), narrow base of tumor (P < 0.01), and increased fibrinogen (FIB) (P < 0.01) are significant risk factors of embolism in CM patients. However, sex, age, body mass index, smoking, left ventricular ejection fraction, diabetes, hyperlipidemia, atrial fibrillation, valvular heart disease, coronary heart disease, tumor size, platelet count, white blood cells, and hemoglobin were not associated with embolism (all P > 0.05).ConclusionsNYHA class (I/II), hypertension, irregular tumor surface, atypical tumor location, the narrow base of tumor, and increased FIB were significant risk factors of embolism in CM patients. For CM patients with these factors, early surgery might be beneficial to prevent embolism.
Highlights
The risk factors contributing to embolism in cardiac myxoma (CM) are yet controversial
Patient characteristics A meta-analysis was performed to assess the 12 risk factors, of which New York Heart Association (NYHA) class (I/II) (OR = 2.98, 95% confidence interval (CI) = 1.66–5.33, P < 0.01) (Fig. 2) and hypertension (OR = 1.41, 95% CI = 1.04–1.92, P = 0.03) (Fig. 3) significantly increased the risk of embolism in CM patients
Irregular tumor surface (OR = 3.99, 95% CI = 3.04–5.25, P < 0.01) (Fig. 4), atypical location (OR = 1.81, 95% CI = 1.13–2.88, P = 0.01) (Fig. 5), and narrow base (MD = -0.36, 95% CI = -0.51–-0.22, P < 0.01) (Fig. 6) significantly increased the risk of embolism in CM patients, while tumor size (MD = -0.10, 95% CI = -0.76–0.57, P = 0.78) was not associated with the condition
Summary
The risk factors contributing to embolism in cardiac myxoma (CM) are yet controversial. This systematic review and meta-analysis aimed to clarify the risk factors of embolism for the CM patients. The manifestations of CM patients include obstruction, preoperative embolization, and constitutional symptoms. Several risk factors of embolism are recently reported [5,6,7,8,9,10,11,12,13,14,15,16], some are controversial. A previous study [17] showed that the small size of the tumor was an independent risk factor for embolism, whereas other studies neither found any association [14] nor presented a contrary conclusion [13].
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