Cardiac Masses Research Articles

Endovascular Removal of Thrombus and Right Heart Masses Using the AngioVac System: Results of 234 Patients from the Prospective, Multicenter Registry of AngioVac Procedures in Detail (RAPID)

PurposeTo assess device and procedural safety and technical success associated with the use of the AngioVac System to remove vascular thrombi and cardiac masses. Materials and MethodsThe Registry of AngioVac Procedures in Detail (RAPID) study prospectively collected data for 234 patients receiving treatment with AngioVac at 21 sites between March 2016 and August 2019: 84 (35.9%) with caval thromboemboli (CTEs), 113 (48.3%) with right heart masses (RHMs), 20 (8.5%) with catheter-related thrombi (CRTs), and 4 (1.7%) with pulmonary emboli (PEs). Thirteen patients had a combination of procedures during the same admission. ResultsUsing the AngioVac system, 70%–100% thrombus or mass removal was achieved in 73.6% of patients with CTEs, 58.5% of patients with RHMs, 60% of patients with CRTs, and 57.1% of patients with PEs. Extracorporeal bypass time was < 1 hour for 176 (75.2%) procedures. Estimated blood loss was < 250 mL for 179 procedures (76.5%). Mean hemoglobin decreased from 10.4 g/dL ± 2.9 preoperatively to 9.4 g/dL ± 2.6 postoperatively. Transfusions were administered in 59 procedures (25.2%) with 47 transfusions (78.2%) being ≤ 2 U. There were 36 procedure-related complications, including 1 death. ConclusionsThe RAPID registry data demonstrate that the AngioVac System can be safely and effectively used to remove vascular thrombi and cardiac masses across a broad range of patient populations. The limited use of the device to remove pulmonary emboli in the present series precludes recommending the use of the AngioVac device for this indication.

Cardiac Masses: Pathological and Surgical Features - A Multicenter Study.

IntroductionThis study aimed to review the surgical excision results and pathological diagnostic features of rarely observed intracardiac masses in the light of the literature. Diagnosis and treatment approaches and complications were evaluated.MethodsForty patients (26 females, mean age 52.1±18.1 years, and 14 males, mean age 48.1±20.5 years), who had undergone surgery for intracardiac mass between January 2008 and December 2018, were included in this study. The patients’ data were analyzed retrospectively from the medical records of both centers.ResultsWhen the pathological diagnoses were examined, 85.8% of the masses (n=35) were observed to be benign (benign tumor + hydatid cyst) and 14.2% (n=5) were malignant tumors. The masses were most commonly located in the left atrium (75%, n=30), and this was followed by the right ventricle (12.5%, n=5), right atrium (7.5%, n=3), and left ventricle (5%, n=2). Of the patients, 7.5% (n=3) died during the early postoperative period, while the remaining 92.5% (n=37) were discharged with healing. In the histopathological diagnosis of the patients, in whom in-hospital major adverse cardiovascular events were observed, there was malignancy in two cases.ConclusionIntracardiac masses, which have pathological features, are severe life-threatening problems. In-hospital mortality is frequent, especially in malignant tumors.

Cardiovascular manifestations in juvenileonset Behcet&amp;apos;s disease: unusual mode of revelation

Background: Behcet’s disease is a systemic vasculitis with unusual thrombosis, especially in children. Intracardiac localization is rare. The site of choice is the right ventricle. It may be isolated, but must necessarily seek other vascular attacks, in particular an aneurysmal pathology of pulmonary arteries. Its clinical expression is not specific. Case Presentation: An 8-years-old boy was hospitalized for an isolated prolonged fever with marked inflammatory state. No infectious symptoms were identified. Electrocardiogram showed a right branch block and negative T waves in V1-V3 leads. Transthoracic echocardiography revealed multiple right ventricular masses, associated with minimal pericardial effusion. These masses have various sizes and are lining right side of interventricular septum and pulmonary infundibulum without right ventricular outflow tract obstruction. Thoracic computerized tomography scan and cardiac magnetic resonance imaging confirmed that cardiac masses were multiples thrombi filling right ventricle and pulmonary artery. Thrombophilia panel assessment and eye fundus examination were normal. The patient was not a carrier of the HLA B51 gene. Juvenile Behcet’s disease was the final diagnostic. Treated by anticoagulant and corticotherapy, the clinical and ultrasound course of the patient was favorable. A 3-year follow up didn’t show a recurrence of these thrombi. Conclusion: Regression of thrombus under anticoagulant, of fever and inflammatory syndrome under corticosteroid therapy, is a good retrospective diagnostic criterion.

Case Report: Intracardiac Mass, the Importance of Early Diagnosis and Surgical Intervention

Background: Cardiac masses are not rare findings; they can be primary or secondary. The differential diagnosis may need surgical intervention in most cases. Case summary: A 42-year female presented with complaints of dyspnea, palpitations, ventricular premature beats, attacks of non-sustained ventricular tachycardia. Echocardiography revealed a myocardial septal mass on both sides in the right and left ventricles. The decision to operate was taken and the masses were removed. It was proved by histopathologic examination to be metastatic from her skin melanoma. Clinically, arrhythmias subsided. Conclusion: The decision of surgery proved unavoidable. Early diagnosis by surgical intervention is important for effective treatment.

EACVI survey on the management of patients with patent foramen ovale and cryptogenic stroke.

The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate the current practice for the assessment and management of patients with suspected patent foramen ovale (PFO) and cryptogenic stroke. In total, 79 imaging centres from 34 countries across the world responded to the survey, which comprised 17 questions. Most non-invasive investigations for PFO were widely available in the responding centres, with the exception of transcranial colour Doppler which was only available in 70% of sites, and most commonly performed by neurologists. Standard transthoracic echocardiography, with or without bubbles, was considered the first-level test for suspected PFO in the majority of the centres, whereas transoesophageal echocardiography was an excellent second-level modality. Most centres would rule out atrial fibrillation (AF) as a source of embolism in all patients with cryptogenic stroke (63%), with the remainder reserving investigation for patients with multiple AF risk factors (33%). Cardiac magnetic resonance was the preferred tool for identifying other unusual aetiologies, like cardiac masses or thrombi. After PFO closure, there was variation in the use of antiplatelet therapy: a quarter recommended treatment for life, while only 12% recommended 5 years as stipulated in the guidelines (12%). Antibiotic prophylaxis prior to dental or endoscopic procedures was not recommended in 41% of centres, contrary to what the guidelines recommended. Our survey revealed a variable adherence to the current recommendations for the diagnosis and management of patients with cryptogenic stroke and PFO. Efforts should focus on optimizing and standardizing diagnostic tests and treatment of this condition.

Transatrial stenting for long-term management of cardiac tumor obstruction of the right atrium in 3 dogs.

BackgroundVenous obstruction in dogs caused by large intracardiac masses can result in severe morbidity with few safe treatments.Hypothesis/ObjectivesRetrospective study to report results after transatrial stent placement in dogs with naturally occurring cardiac masses causing venous obstruction.AnimalsThree client‐owned dogs diagnosed with large cardiac masses.MethodsRetrospective study of patients that received transatrial stents extending from the caudal vena cava, across the right atrium, and into the cranial vena cava (CrVC). Procedures, complications, and outcomes were recorded based upon medical records, referring veterinarians, and client communications.ResultsTwo dogs had similar clinical signs suggestive of congestive hepatopathy including marked ascites and lethargy. One dog had clinical signs of CrVC syndrome including head and neck swelling with pitting edema and pleural effusion. After stent placement, venous pressure gradients were decreased and repeat angiography confirmed that vascular patency was reestablished. Resolution of clinical signs was marked in all 3 dogs with only mild complications including tachyarrhythmias and hypertension in 1 dog during the perioperative period. Two dogs that required additional transatrial stent placement for reobstruction 6 and 14 months later improved after the second stent implantation. Survival times poststenting for the dogs were 3, 21, and 37 months, with cause of death related to the cardiac tumor in all dogs.Conclusions and Clinical ImportanceEndovascular transatrial stenting may provide a long‐term palliative treatment option for dogs with clinical signs attributable to tumor‐induced venous obstruction when more traditional treatments are declined or not indicated.

Cardiac Masses: The Role of Cardiovascular Imaging in the Differential Diagnosis.

Cardiac masses are space occupying lesions within the cardiac cavities or adjacent to the pericardium. They include frequently diagnosed clinical entities such as clots and vegetations, common benign tumors such as myxomas and papillary fibroelastomas and uncommon benign or malignant primary or metastatic tumors. Given their diversity, there are no guidelines or consensus statements regarding the best diagnostic or therapeutic approach. In the past, diagnosis used to be made by the histological specimens after surgery or during the post-mortem examination. Nevertheless, evolution and increased availability of cardiovascular imaging modalities has enabled better characterization of the masses and the surrounding tissue. Transthoracic echocardiography using contrast agents can evaluate the location, the morphology and the perfusion of the mass as well as its hemodynamic effect. Transesophageal echocardiography has increased spatial and temporal resolution; hence it is superior in depicting small highly mobile masses. Cardiac magnetic resonance and cardiac computed tomography are complementary providing tissue characterization. The scope of this review is to present the role of cardiovascular imaging in the differential diagnosis of cardiac masses and to propose a step-wise diagnostic algorithm, taking into account the epidemiology and clinical presentation of the cardiac masses, as well as the availability and the incremental value of each imaging modality.

Right heart failure due to benign metastasizing leiomyoma: a case report of this exceedingly rare condition and review of the literature.

BackgroundBenign metastasizing leiomyoma (BML) is a smooth muscle tumour of genital origin occurring in women with a history of uterine or pelvic leiomyoma. Although histologically benign, it exhibits metastatic behaviour. Lungs are the most common site of metastasis. The heart is a rare site and metastasis at this location has been described in just few cases.Case summary A 42-year-old woman with a resected uterine leiomyoma and a subsequent and still not-resected left periovarian solid mass began complaining of shortness of breath 2 weeks before presentation. Echocardiography showed a mass located in the right ventricular cavity, enlargement of the right ventricle, and severe tricuspid regurgitation. Cardiac magnetic resonance revealed two masses suggestive of tumours in the right ventricle causing right ventricular outflow tract obstruction. Cardiac surgery was performed and, intraoperatively, a third small mass was detected on the tricuspid valve. The masses were resected, and tricuspid valve replacement was performed. Ten days later, the patient underwent an abdominal surgery for the pelvic mass resection. Immunohistochemical analysis of the cardiac and pelvic masses corroborated the diagnosis of benign leiomyomas. The patient was discharged in good clinical condition.Discussion Benign metastasizing leiomyoma to the heart is a rare condition. The pathogenesis remains controversial and includes: (i) vascular or lymphatic spread of myomatous tissue cells when leiomyoma resection or hysterectomy is performed and (ii) smooth muscle cell proliferation in multiple regions. The more usual locations of BML in the heart seem to be the tricuspid valve and the right face of the interventricular septum.

Cardiac tumor in a newborn: case report

Background . The topicality of this work lies in that benign or malignant cardiac tumors are a fairly rare pathology. In children this pathology is represented by benign neoplasms, of which rhabdomyosarcoma accounts for 39.3-58.6% of all cardiac tumors, fibromyosarcoma — for 19%, and other types of cardiac tumors are rarely found. Small-sized rhabdomyosarcoma may undergo spontaneous regression. The most common method of cardiac tumor diagnosis is echocardiography (Echo-CG). Case description . Newborn К., carried to full-term. Heart auscultation had revealed an abnormal systolic murmur. Emergency Echo-CG revealed a voluminous mass of a dual structure, one part of which was located in the interventricular septum (IVS) and the other — in the left ventricular outflow tract (LVOT). This pathology was not found during the prenatal period. The infant was consulted at the Research Center of Cardiovascular Surgery (RC CVS) in Penza where a dynamic follow-up was recommended. Conclusion . This case attests to that the clinical picture of abnormal cardiac masses is nonspecific and requires close medical attention of a neonatologist and a cardiologist, as well as the ultrasound screening during dynamic follow-up of pregnant women.

Abstract 13399: Variable Exposure to Echocardiography Pathology and Core Competencies Among Cardiology Fellows-in-training

Introduction: Current guidelines recommend interpretation of at least 300 echocardiograms to achieve competency in echocardiography for independent practice (level II COCATS). Recommended core competencies in echocardiography include proficiency in evaluating native and prosthetic valve diseases, pulmonary hypertension and right heart dysfunction, and suspected cardiac masses or endocarditis, among others. Whether the recommended number of cases allows for adequate exposure to the various core competencies, however, is unclear. Hypothesis: We investigated whether certain core competencies are less commonly encountered when using the recommended case numbers by current guidelines. Methods: We reviewed echocardiograms interpreted by 10 of our cardiology fellows (2 per year) who began training from July 2015 through July 2019. We recorded core competency measures encountered in the first 300 echocardiograms interpreted by each fellow, including measures of left and right ventricular dysfunction, valvular diseases, cardiac masses, aortic disease, and pericardial disease. Paired T-test was used to compare the mean occurrence between different core competencies. Results: Among the 3000 echocardiograms reviewed, abnormal wall motion was the most common pathology encountered, whereas each other core competency was relatively less common (p&lt;0.05 for all comparisons, see plots below). Deficiencies in core competencies included: 9/10 fellows had no cases of aortic dissection, 3/10 had no cases of valvular mass, 2/10 had no cases of cardiac chamber mass, 2/10 had no cases of cardiac tamponade, and 1/10 had no cases of prosthetic valve dysfunction. Conclusions: The recommend number of echocardiograms in current guidelines does not ensure adequate exposure to all areas of echocardiography core competency. Educators should consider strategies to supplement learning in these areas to ensure experience in all areas of echocardiography core competency.

Abstract 14130: Effect of Angiovac on Right Ventricular Function Following Removal of Right Atrial Masses in Patients With and Without Malignancy

Introduction: The AngioVac thrombectomy system (AngioDynamics Inc, Queensbury, NY) is an FDA approved device for removal of thrombi and emboli. Prior studies have shown procedural success for removal of right atrial (RA) and caval masses. This study aims to assess the effect of AngioVac on right ventricular (RV) function in patients undergoing removal of RA masses. Methods: Retrospective institutional study of patients undergoing removal of RA masses with AngioVac at a single tertiary medical center were included. Right ventricular fractional change (RVFC) and tricuspid annular plane systolic excursion (TAPSE) values were collected from echocardiograms before and after AngioVac or obtained manually if not present in the report. Paired 2-sample t test was done to assess for a significant difference between the two values. Results: The mean difference in RVFC before and after AngioVac was 1.6%, with a p-value of 0.327. Ten of the 28 patients had active malignancy, with a mean difference in RVFC of 0.8% and a p value of 0.683. The mean difference in the TAPSE group was 0.07mm and a p value of 0.48. Eight of the 19 patients had active malignancy, with a mean difference in TAPSE of 0.2mm corresponding to a p-value of 0.24. There was no significant difference in left ventricular ejection fraction before and after AngioVac (mean difference of 2.5%, p-value of 0.11). Conclusions: These findings suggest that use of the AngioVac device for removal of RA masses does not cause significant derangements in RV function by echocardiographic assessment. It is a well-tolerated procedure in patients with preprocedural normal RV function. These findings also further assess the use of AngioVac in patients with both right sided cardiac masses and active malignancy.

Prognostic utility of differential contrast-enhancement patterns on late gadolinium enhancement cardiac MRI (LGE-CMR) in patients with cancer-associated cardiac masses

Abstract Background LGE-CMR tissue characterization is widely used to identify cardiac masses (CMASS) in cancer patients – including neoplasm (NEO) and thrombus (THR). Prognostic utility of their differential LGE patterns is unknown. Purpose To determine incremental prognostic utility of LGE patterns in CMASS Methods The population comprised of cancer patients with CMASS on LGE-CMR, for which etiology was classified based on presence (NEO) or absence (THR) of enhancement, and controls matched for cancer type/stage. LGE-CMR tissue properties of NEO was classified based on extent of contrast enhancement – diffusely enhancing (DE), mixed (ME), and predominantly avascular (PA). Clinical follow up was performed for embolic events within 6 months of CMR and all-cause mortality. Results 330 cancer patients (55% M; 55±16yo) with an array of cancer diagnoses (19% sarcoma, 17% GI, 13% GU) were studied. Among CMASS+ pts (n=190), 66% had NEO and 34% had THR on LGE. All THR were non-enhancing. Among NEO, LGE pattern was variable (46% DE, 41% ME, 13% PA); ME lesions were larger than other groups (Fig. 1A). Quantitative tissue properties were consistent with qualitative groups, as evidenced by stepwise variation in signal intensity and CNR. Cumulative embolic events were 3-fold higher in CMASS+ than controls (All: 20% vs. 7%, p=0.001; PE: 13% vs. 5%, p=0.02; CVA/systemic embolism: 10% vs. 3%, p=0.01). Median time to event was 1.3 months [IQR 0.1–2.3] from CMR. Aggregate events were similar between NEO and THR, reflecting similar rates of PE and CVA (p=NS). Among CMASS pts with embolic events, 56% were on anticoagulation at time of event (59% NEO, 50% THR, p=0.61). Regarding CMASS morphology, emboli were 3-fold higher among intracavitary (IC) or highly mobile (HM) CMASS (IC: 25% vs 7%, p&amp;lt;0.001; HM: 38% vs 12%, p=0.001). Regarding location, right sided CMASS were associated with a 3–5 fold increase in PE (IC: 19% vs 6%; HM: 35% vs 7%, both p&amp;lt;0.001) and similar CVA events among left sided CMASS (IC: 17% vs. 6%, p=0.02; HM: 33% vs 6%, p=0.05). Embolic events were similar when partitioned based on quantitative LGE patterns between patients with and without embolic events. As for all-cause mortality, NEO on CMR conferred increased mortality than THR (HR 3.06 [CI=1.84–5.1], p&amp;lt;0.001) and matched controls (HR 2.08 [CI=1.42–3.04], p&amp;lt;0.001) during a median follow-up of 9.4 months [IQR 3.6–23.2]. Among NEO subgroups (Fig. 1B), survival was lower in patients with heterogeneous LGE patterns vs matched controls: the lowest survival in ME (p=0.002) suggests increased vascularity and tumor hypoxia/necrosis associated with aggressive tumors and hence larger lesions. Conclusions Among cancer patients, CMR-evidenced CMASS confers high short-term embolic risk, which are equivalently common between NEO and THR. Intra-cavitary location and increased mobility augment embolic risk irrespective of CMASS tissue properties whereas differential LGE patterns on CMR strongly impact prognosis. Funding Acknowledgement Type of funding source: None

Diagnostic accuracy of cardiac computed tomography and 18F-fluorodeoxyglucose with positron emission tomography/computed tomography in cardiac masses

Abstract Background Understanding the nature of cardiac masses represents a challenge for clinicians in order to select the appropriate therapeutic strategies. The diagnostic accuracy of cardiac computed tomography (CT) and 18F-fluorodeoxyglucose (18F-FDG) with positron emission tomography/CT (PET/CT) in identifying the nature of cardiac masses has not been evaluated before in a large population. Purpose To assess the diagnostic value of CT and 18F-FDG PET/CT in defining the nature of cardiac masses, integrating morphologic features and metabolic activity. Methods Out of 223 we selected a final cohort 60 patients which underwent cardiac CT scan and 18F-FDG PET/CT. All masses had histological certain, apart from thrombi, in which was defined radiologic resolution after adequate anticoagulant treatment. For each mass, eight morphologic CT signs and standardized uptake value (SUVmax, SUVmean), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) in 18F-FDG PET, were evaluated. Results Twenty patients had benign cardiac masses and 40 patients malignant cardiac masses. Irregular tumour margins, pericardial effusion, invasions, solid nature of the mass, mass diameter, TC contrast up-take and pre-contrast characteristics were strongly associated with the malignant nature of cardiac masses (p&amp;lt;0.001). Additionally, the presence of at least four CT signs was able to discriminate malignancies, withsensitivity of 95% and specificity of 95% (AUC=0.988, 95% CI 0.969–1). The mean value of SUVmax, SUVmean, MTV and TLG was significantly higher in malignant cardiac masses than in benign lesions (p&amp;lt;0.001). ROC curve for diagnostic accuracy of 18F-FDG PET/CT parameters in detecting malignant lesions showed an excellent performance of SUV (AUC=0.948, 95% CI 0.891–1), MTV (AUC=0.928, 95% CI 0.841–1) and TLG (AUC=0.961, 95% CI 0.902–1). Conclusions In patients with cardiac masses, cardiac computed tomography and 18F-FDG PET/CT findings provide independent and incremental prognostic information regarding their nature. A systematic use of CT and 18F-FDG PET/CT is therefore useful for diagnostic and therapeutic purposes. PET-CT evaluation of cardiac masses Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): S. Orsola Malpighi Hospital, University of Bologna

Outcomes in patients with cardiac masses: the underestimated burden of pseudotumours

Abstract Background Cardiac masses (CMs) include benign and malignant formations. So far, clinical presentation and prognosis have been reported only in small series without discriminating between subtypes. We investigated the clinical presentation and long-term prognosis of patients with cardiac masses stratifying our results according to the lesions' nature. Methods We enrolled all consecutive patients admitted to our Institution between 1999 and 2018 with imaging evidence of CMs. Definitive diagnosis was achieved by histologic examination or by radiological evidence of thrombotic resolution after anticoagulant treatment. The study population was classified as benign or malignant and subsequently into 4 subtypes: pseudo-tumours, primary benign tumours, primary malignant tumours and secondary tumours. Cardiovascular and non-cardiovascular mortality was described. Results We identified 172 patients with CMs, 125 benign and 47 malignant. Benign lesions were often incidentally diagnosed in the left heart chambers whereas malignancies were usually detected in the pericardium and right sections, resulting in more advanced symptoms. Over time – median follow-up of 48 months - survival of patients with benign formations was three-fold greater than patients with malignancies (p&amp;lt;0.001) with no differences in cardiovascular mortality. Patients with pseudo-tumours showed a significantly lower survival than primary benign tumours (p=0.018) while no difference was found within the malignant stratum between primary and secondary neoplasms. Conclusions CMs are a heterogeneous entity where advanced symptoms and a pericardial involvement suggest malignant forms, which exhibit a poor outcome. Among patients with benign lesions, pseudo-tumours were associated with reduced survival, supposedly as a consequence of the different underlying conditions. Funding Acknowledgement Type of funding source: None

The use of Cardiac MRI in diagnosis of infective endocarditis: a comparative study with echocardiography

Abstract Introduction Echocardiography is a reliable imaging tool in diagnosing infective endocarditis (IE) according to “modified Dukes criteria”; however, it lacks tissue characterization of cardiac masses, transthoracic echocardiography (TTE) has low sensitivity in detection of vegetations, and moreover, transesophageal echo (TEE) is considered semi-invasive and intolerable in some situations. On the other hand, cardiac magnetic resonance (CMR) is a powerful true 3D imaging tool with wide field of view, and superior capability of tissue characterization of cardiac masses; however, modest information is available about utility of CMR in diagnosing IE. Purpose To assess the feasibility of CMR to identify vegetations and complications of IE, and compare obtained findings obtained with those obtained from echocardiography regarding: number and size of vegetations, detection of cardiac complications (e.g. aortic root abscess, periannular abscess, and shunts). Materials and methods Eighty consecutive patients with suspected IE were enrolled in the study. All patients underwent TTE; only those with left-sided lesions underwent TEE. When clinical situation allowed, CMR examination using 1.5 Tesla magnet were performed: SSFP sequence for mobile masses (SSFP), T1W (± fat suppression) and T2W, first-pass perfusion, and delayed hyperenhancement were used. Moreover, chest and abdominal survey was done. Results Sixty-one patients (45 males and 16 females) were able to undergo and complete CMR study. Affection of tricuspid valve was seen in 39.3%, mitral 31.1%, aortic 24.6%, and pulmonary 4.9% of cases. All vegetations visualized by echocardiography were also clearly detected by CMR. The sensitivity, specificity, accuracy and Kappa agreement of CMR with echocardiography in depicting &amp;gt;0.5cm vegetations were all 100%. By tissue characterization, vegetations resemble features of thrombi (with variation in signal intensity according to age of vegetation). However, in some cases, masses have a unique pattern that is different from vegetations of IE, and subsequently other diagnoses were suggested (e.g. fibroelastoma, Libman-Saks endocarditis). In 22 patients, CMR provided more information than echocardiography, and in 6 patients, CMR changed completely the diagnosis. Conclusion Cardiac MRI is a powerful imaging tool in diagnosis of IE and its complications. In comparison with echocardiography, CMR can identify the presence, numbers, and size of vegetations accurately. Moreover, with its unique ability of tissue characterization, CMR helps distinguish vegetations from other masses; therefore changes the diagnosis of IE and subsequent management in some patients. Funding Acknowledgement Type of funding source: None

Right atrial mass-multimodality imaging-Massive lipomatous hypertrophy of the atrial septum.

Asymptomatic cardiac masses are often diagnosed incidentally. Massive lipomatous hypertrophy can be confused for other cardiac masses and need careful evaluation including multimodality imaging to manage appropriately.

Cardiac Magnetic Resonance Evaluation of Cardiac Masses in Patients with Suspicion of Cardiac Masses on Echo or Computed Tomography

Objectives:In recent years, cardiac magnetic resonance (CMR) imaging has emerged as an important tool in the identification and characterization of cardiac masses. No imaging data on cardiac masses are available from Pakistan. We aimed to review the clinical presentation, CMR findings, and outcome of patients referred for CMR due to suspicion of cardiac masses on echocardiogram or computed tomography (CT).Material and Methods:We reviewed all the patients referred for CMR at Aga Khan University Hospital, Karachi, from January 2011 to March 2020, with the suspicion of cardiac mass on echocardiogram and/or CT. Only those with the confirmed diagnosis of cardiac mass on CMR were included in the study.Results:A total of 27 patients were referred for CMR from January 2011 to March 2020, with the suspicion of cardiac mass on echocardiogram and/or CT. Four patients were excluded as no cardiac mass was found on CMR. Out of 23 cases, majority (n = 15, 65%) were female, age ranging from 3 months to 70 years, with a mean age of 40 ± 22 years. Shortness of breath was the main presenting symptom (n = 19, 83%). Echocardiogram was the initial imaging modality done in all the patients while CT was also performed in 6 patients (26%). Out of 23 patients, 4 (17%) were diagnosed to have thrombus on CMR. In two cases, it was in the left ventricle with evidence of myocardial infarction on late gadolinium images. Myxoma was the most common tumor diagnosed on CMR in 6 patients (26%) followed by rhabdomyoma (n = 3, 13%) and fibroma (n = 2, 8.7%). There were three malignant primary tumors of the heart based on CMR appearances and one with tumor thrombus extension of hepatocellular carcinoma in the right atrium from inferior vena cava. Two patients were diagnosed to have non-neoplastic lesions – one with large intracardiac hydatid cyst and one with possible large fungal vegetation. Among 23 patients, 9 patients (39%) underwent surgery, 5 with myxoma, 2 with rhabdomyoma, 1 with fibroma, and 1 with fibroelastoma. Findings on surgery and histopathology matched the CMR diagnosis in all the patients except the one with the CMR diagnosis of myxoma in which histopathology was consistent with thrombus.Conclusion:CMR can play an important role in confirming the presence or absence of a mass in the heart. It can also provide differentiation of non-neoplastic and neoplastic lesions and among different types of neoplastic lesions with reasonable accuracy. However, the limitations of CMR must be recognized.

Abstract 2965: Aerobic exercise delays intraductal breast cancer growth and suppresses doxorubicin-induced skeletal and cardiac muscle toxicities

Abstract Aerobic exercise enacts physiologic adaptations across multiple tissue types that have positive effects on health and well-being in a number of chronic diseases. In cancer patients, exercise can improve quality of life by improving mood, reducing fatigue, and increasing therapy tolerance. Preclinical evidence suggests that exercise may also have direct effects on the tumor, such as improving perfusion, limiting hypoxia, and increasing immune cell infiltration. Furthermore, physiologic adaptations to exercise may protect against treatment toxicities. The goal of this project was to analyze the effect of aerobic exercise on breast cancer growth and doxorubicin-induced toxicity in a preclinical setting. These studies utilized retired breeder, female BALB/c mice. Aerobic exercise was modeled by singly-housing mice in cages with access to wireless, low-profile voluntary wheel running. Sedentary controls were singly-housed with plastic huts. To assess the impact of exercise on tumor growth, mice were intraductally injected with murine EMT6 breast cancer cells (103 cells in 5 µL) and then randomized into sedentary or exercising groups. Tumor volume was measured, and endpoint was defined as tumor volume of 1200 mm3. To examine the effect of exercise on doxorubicin-induced toxicity, non-tumor bearing mice were randomized into sedentary or exercising groups and given 3 intraperitoneal injections of doxorubicin (total dose 11 mg/kg) on days 10, 13, and 16 after randomization. The experiment was terminated on day 21. In both studies, mice were euthanized at endpoint and tissues were harvested, weighed, and either snap-frozen, or OCT- or paraffin-embedded. The results showed that aerobic exercise delayed tumor growth and improved survival in the intraductal EMT6 model. Proteomic profiling with a cytokine array revealed differential expression of Reg3G, MMP-9, and Tissue Factor between sedentary and exercising tumors. Moreover, chemotherapy treatment trended to decrease skeletal and cardiac muscle masses relative to untreated controls, and exercise prevented these effects. Doxorubicin also induced differential cardiac gene expression of α-MHC, β-MHC, and SERCA 2a relative to untreated controls, and exercise prevented these effects in 2 of 3 markers. In conclusion, aerobic exercise delayed tumor growth and improved survival in an intraductal model of breast cancer. Exercise also suppressed doxorubicin-induced skeletal and cardiac muscle toxicities. These findings suggest that aerobic exercise may have the potential to improve therapy outcomes by affecting both tumor growth and chemotherapy toxicities when implemented during treatment. Citation Format: Zachary Wakefield, Angela Bundy, Sharon Lepler, Christine Pampo, Lori Rice, Dietmar Siemann. Aerobic exercise delays intraductal breast cancer growth and suppresses doxorubicin-induced skeletal and cardiac muscle toxicities [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2965.

Angiotensin-(1-7) Improves Integrated Cardiometabolic Function in Aged Mice.

Angiotensin (Ang)-(1-7) is a beneficial renin–angiotensin system (RAS) hormone that elicits protective cardiometabolic effects in young animal models of hypertension, obesity, and metabolic syndrome. The impact of Ang-(1-7) on cardiovascular and metabolic outcomes during aging, however, remains unexplored. This study tested the hypothesis that Ang-(1-7) attenuates age-related elevations in blood pressure and insulin resistance in mice. Young adult (two-month-old) and aged (16-month-old) male C57BL/6J mice received Ang-(1-7) (400 ng/kg/min) or saline for six-weeks via a subcutaneous osmotic mini-pump. Arterial blood pressure and metabolic function indices (body composition, insulin sensitivity, and glucose tolerance) were measured at the end of treatment. Adipose and cardiac tissue masses and cardiac RAS, sympathetic and inflammatory marker gene expression were also measured. We found that chronic Ang-(1-7) treatment decreased systolic and mean blood pressure, with a similar trend for diastolic blood pressure. Ang-(1-7) also improved insulin sensitivity in aged mice to levels in young mice, without effects on glucose tolerance or body composition. The blood pressure–lowering effects of Ang-(1-7) in aged mice were associated with reduced sympathetic outflow to the heart. These findings suggest Ang-(1-7) may provide a novel pharmacological target to improve age-related cardiometabolic risk.

Bloody Pericardial Effusion with a Huge Pericardial Mass: A Case Report

Nowadays, the early diagnosis of tumoral diseases is more possible and accurate with multiple diagnostic imaging modalities such as chest X-ray, echocardiography, computed tomography, and magnetic resonance imaging, especially for cardiac tumors which are usually asymptomatic, even in large sizes. In cardiac masses, the patients' presentations are non- specific and dependent on the tumor size and site as well as its compressive effect on the adjacent structures. On the other hand, the first and last signs could be sudden cardiac death. However, cardiac masses are either benign or malignant and metastatic in their malignant type, and their definite diagnosis is only possible by surgical tumor resection and tissue biopsy. In this paper, we describe an old patient with severe pericardial effusion and an unusual intrapericardial tumor in transthoracic echocardiography, representing a rare case of a giant ectopic thymoma after surgical resection and pathologic assessment.