Sex-Related Disparities in Cardiac Masses: Clinical Features and Outcomes
Abstract
:1. Introduction
2. Methods
2.1. Study Population
2.2. Data Collection and Follow Up
2.3. Echocardiographic Features in Women vs. Men
2.4. Statistical Analysis
3. Results
3.1. Female vs. Male: Clinical Features
3.2. Female vs. Males: Histological Subtypes
3.3. Female vs. Male: Echocardiographic Features
3.4. Outcomes according to Sex in Cardiac Masses
4. Discussion
4.1. Sex-Related Differences in Clinical Manifestations
4.2. Sex-Related Differences in Clinical Outcomes
4.3. Sex-Related Differences in Echocardiographic Features
5. Study Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
BMI | Body Mass Index |
CCT | Cardiac Computed Tomography |
CM | Cardiac Masses |
CMR | Cardiac Magnetic Resonance |
LVEF | Left Ventricular Ejection Fraction |
WHO | World Health Organization |
18-FDG-PET | 18-Fluorodeoxyglucose Positron Emission Tomography |
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Total Population N = 321 | Female Patients N = 172 | Male Patients N = 149 | p-Value | |
---|---|---|---|---|
Age in years, mean ± SD | 59.8 ± 15.4 | 61.4 ±15.7 | 57.9 ± 15.4 | 0.02 |
BMI in kg/m2, mean ± SD | 25.4 ± 4.4 | 24.8 ± 4.1 | 26.3 ± 3.8 | 0.01 |
Cardiovascular risk factors | ||||
Smoking habit, n (%) | 160 (49.8) | 60 (34.8) | 100 (66.9) | <0.001 |
Hypertension, n (%) | 180 (56.1) | 97 (56.4) | 83 (55.7) | 0.84 |
Dyslipidemia, n (%) | 140 (43.6) | 81 (47) | 59 (39.9) | 0.22 |
DM, n (%) | 48 (14.9) | 24 (13.9) | 24 (16.2) | 0.27 |
Medical History | ||||
Congestive Heart failure, n (%) | 40 (12.5) | 15 (8.7) | 25(16.8) | 0.06 |
Prior stroke, n (%) | 70 (21.8) | 32 (18.6) | 28 (18.8) | 0.12 |
Vasculopathy, n (%) | 78 (24.8) | 42 (24.4) | 36 (24.2) | 0.19 |
History of neoplasia, n (%) | 0.53 | |||
None | 210 (65.4) | 116 (67.4) | 94 (63.1) | |
Benign | 32 (9.9) | 21 (12.2) | 11 (7.4) | |
Malignant | 79 (24.7) | 41 (23.8) | 38 (25.5) | |
CHA2DS2-VASc, mean ± SD | 2.6 ± 1.7 | 2.7 ± 1.6 | 2.4 ± 1.7 | 0.06 |
Total Population N = 321 | Female Patients N = 172 | Male Patients N = 149 | p-Value | |
---|---|---|---|---|
Clinical features | ||||
Malignant lesion, n (%) | 99 (30.8) | 35 (20.3) | 64 (43) | <0.001 |
Accidental diagnosis, n (%) | 137 (42.7) | 71 (41.3) | 66 (44.3) | 0.56 |
Dyspnea, n (%) | 129 (40.2) | 73 (42.4) | 56 (37.6) | 0.36 |
NYHA Classification, n (%) | 0.26 | |||
Class I–II | 244 (76) | 132 (76.8) | 112 (75.2) | |
Class III–IV | 77 (24) | 40 (23.2) | 37 (24.8) | |
Chest pain, n (%) | 52 (16.2) | 30 (17.4) | 22 (14.8) | 0.49 |
Peripheral embolism, n (%) | 43 (13.4) | 32 (18.6) | 11 (7.4) | 0.003 |
Pulmonary embolism, n (%) | 44 (13.7) | 24 (13.9) | 20 (13.4) | 0.1 |
Location, n (%) | 0.087 | |||
Right cardiac chambers, n (%) | 93 (29) | 45 (26.2) | 48 (32.2) | |
Left cardiac chambers, n (%) | 174 (54.2) | 104 (60.5) | 70 (47) | |
Pericardium, n (%) | 36 (11.2) | 15 (8.7) | 21 (14) | |
Great Vessels, n (%) | 18 (5.6) | 8 (4.6) | 10 (6.8) | |
Laboratory parameters | ||||
Creatinine in mg/dL, mean ± SD | 1.04 ± 0.67 | 0.88 ± 0.65 | 1.22 ±0.8 | 0.002 |
GFR in mL/min, mean ± SD | 80.4 ±26.3 | 84.3 ± 23.1 | 75.8 ±28.9 | 0.003 |
Hb in g/dL, mean ± SD | 12.7 ± 2 | 12.4 ± 1.6 | 13.2 ± 2.1 | 0.001 |
WBC in n/mmc, mean ± SD | 8522 ± 3846 | 8472 ±3121 | 8579 ±4114 | 0.36 |
LDH in U/L, median [IQR] | 231 [155–289] | 222 [143–272] | 244 [135–279] | 0.67 |
CRP in mg/dL, median [IQR] | 1.89 [3.5–0.45] | 1.5 [3.2–0.3] | 1.7 [3.4–0.7] | 0.07 |
Total Population N = 321 | Female Patients N = 172 | Male Patients N = 149 | p-Value | |
---|---|---|---|---|
Benign tumours | 149 (46.4) | 101 (58.7) | 48 (32.2) | <0.001 |
Myxoma | 114 (76.5) | 82 (81.2) | 32 (64.6) | |
Fibroelastoma | 23 (15.4) | 12 (11.2) | 11 (22.9) | |
Lipoma | 5 (3.2) | 2 (2) | 3 (6.3) | |
Fibroma | 3 (2) | 2 (2) | 1 (2) | |
Paraganglioma | 3 (2) | 2 (2) | 1 (2) | |
Hamartoma | 1 (0.7) | 1 (0.9) | 0 (0) | |
Pseudotumours | 73 (22.7) | 36 (20.1) | 37 (24.8) | 0.43 |
Thrombus | 37 (50.7) | 20 (55.56) | 17 (45.9) | |
Cyst | 10 (13.7) | 5 (13.9) | 5 (13.5) | |
Valvular nodule | 10 (13.7) | 3 (8.3) | 7 (18.9) | |
Lipomatosis | 6 (8.3) | 4 (11.1) | 2 (5.4) | |
Reactive inflammatory process | 6 (8.3) | 3 (8.3) | 3 (8.1) | |
Calcification | 3 (4.1) | 0 (0) | 3 (8.1) | |
Cystic atrioventricular node tumour | 1 (1.7) | 1 (2.8) | 0 (0) | |
Primary malignant tumours | 35 (10.9) | 15 (8.7) | 20 (13.4) | 0.21 |
Sarcoma | 31 (88.6) | 14 (93.3) | 17 (85) | |
Lymphoma | 3 (8.6) | 0 (0) | 3 (15) | |
Mesothelioma | 1 (2.8) | 1 (6.7) | 0 (0) | |
Metastatic tumours | 64 (19.9) | 20 (11.6) | 44 (29.5) | <0.001 |
Lymphoma | 23 (35.9) | 5 (25) | 18 (40.9) | |
Lung carcinoma | 8 (12.5) | 2 (10) | 6 (13.6) | |
Sarcoma | 7 (10.9) | 2 (10) | 5 (11.4) | |
Renal and urological tumours | 7 (10.9) | 3 (15) | 4 (9.1) | |
Melanoma | 6 (9.3) | 2 (10) | 4 (9.1) | |
Hepatocellular carcinoma | 5 (7.8) | 1 (5) | 4 (9.1) | |
Colon carcinoma | 4 (6.3) | 1 (5) | 3 (6.8) | |
Gynaecological tumours | 3 (4.7) | 3 (15) | 0 | |
Plasmacytoma | 1 (1.6) | 1 (5) | 0 |
Total Population N = 286 | Female Patients N = 155 | Male Patients N = 131 | p-Value | |
---|---|---|---|---|
Ventricular parameters | ||||
Ejection Fraction in %, mean ± SD | 60.4 ± 9.7 | 62.3 ±8.3 | 58.4 ± 11.2 | 0.001 |
LV EDD in mm, mean ± SD | 46.7 ±6.4 | 45 ± 5.7 | 48.7 ± 6.6 | <0.001 |
LV EDV in mm3, mean ± SD | 92.9 ± 35.1 | 81 ± 24.8 | 107.2 ± 40.9 | <0.001 |
LAV in mL, mean ± SD | 51 ± 5 | 48 ± 3 | 55 ± 4 | 0.067 |
DDF, n (%) | 13 (4.5) | 7 (4.6) | 6 (4.5) | 0.98 |
sysPAP in mmHg, mean ± SD | 34.9 ± 15 | 35.8 ± 18 | 32.8 ± 12.3 | 0.79 |
Mitral regurgitation, n (%) | 0.87 | |||
Mild | 160 (55.9) | 91 (58.7) | 69 (52.7) | |
Moderate/severe | 40 (14) | 20 (12.9) | 20 (15.3) | |
Mitral stenosis, n (%) | 0.2 | |||
Mild | 8 (2.8) | 6 (3.9) | 2 (1.5) | |
Moderate/severe | 12 (4.2) | 8 (5.2) | 4 (3.1) | |
Aortic regurgitation, n (%) | 0.56 | |||
Mild | 61 (21.3) | 36 (23.2) | 25 (19.1) | |
Moderate/severe | 13 (4.5) | 8 (5.2) | 5 (3.8) | |
Aortic stenosis, n (%) | 0.6 | |||
Mild | 22 (7.7) | 11 (7.1) | 11 (8.4) | |
Moderate/severe | 5 (1.7) | 4 (2.6) | 1 (0.8) | |
Tricuspid regurgitation, n (%) | 0.54 | |||
Mild | 159 (55.6) | 88 (56.8) | 71 (54.2) | |
Moderate/severe | 26 (9.1) | 10 (7.6) | 16 (10.3) | |
Pericardial effusion, n (%) | 63 (22) | 21 (13.5) | 42 (32.1) | 0.001 |
Mild, n (%) | 34 (53.9) | 15 (71.4) | 19 (45.2) | |
Moderate/severe, n (%) | 29 (46.1) | 6 (28.6) | 23 (54.7) | |
Mass features | ||||
Infiltration, n (%) | 57 (19.9) | 19 (12.3) | 38 (29) | 0.001 |
Max CM diameter in mm, mean ± SD | 36 ±19.6 | 33.8 ±15.9 | 38.6 ±22.9 | 0.02 |
Inhomogeneity, n (%) | 73 (25.5) | 35 (22.6) | 38 (29) | 0.22 |
Irregular margins, n (%) | 72 (25.2) | 24 (15.5) | 48 (36.6) | <0.001 |
Mobility, n (%) | 143 (50) | 88 (56.8) | 55 (42) | 0.04 |
Sessile mass, n (%) | 129 (45.1) | 62 (40) | 67 (51.1) | 0.02 |
Polylobate mass, n (%) | 72 (25.2) | 29 (18.7) | 43 (32.8) | 0.003 |
Total Population | Female Patients | Male Patients | p-Value | |
---|---|---|---|---|
Benign tumours | 17/149 (11.4) | 14/101 (13.9) | 3/48 (6.3) | 0.27 |
Primary Malignant tumours | 23/35 (65.7) | 8/15 (53.3) | 15/20 (75.5) | 0.12 |
Pseudotumours | 10/73 (13.7) | 5/36 (13.9) | 5/37 (13.5) | 0.62 |
Metastatic tumours | 40/64 (63) | 13/20 (65) | 27/44 (61.4) | 0.51 |
Univariate Analysis | Multivariate Analysis | |||||||
---|---|---|---|---|---|---|---|---|
Odds Ratio | Standard Error | 95% CI | p Value | Odds Ratio | Standard Error | 95% CI | p Value | |
Age | 1.02 | 0.008 | 1.04–1.034 | 0.01 | 1.03 | 0.08 | 1.04–1.01 | <0.001 |
Male Sex | 1.76 | 0.21 | 2.66–1.157 | 0.008 | - | - | - | - |
Smoking | 1.38 | 0.21 | 2.09–0.91 | 0.132 | 1.55 | 0.22 | 2.35–1.001 | 0.049 |
Hypertension | 0.81 | 0.22 | 1.24–0.5 | 0.33 | - | - | - | - |
Dyslipidaemia | 1.11 | 0.21 | 1.69–0.73 | 0.62 | - | - | - | - |
Diabetes Mellitus | 0.75 | 0.28 | 1.29–0.44 | 0.3 | - | - | - | - |
Peripheral artery disease | 1.22 | 0.24 | 1.95–0.76 | 0.41 | - | - | - | - |
Malignant tumour | 9.98 | 0.24 | 15.9–6.26 | <0.001 | 13.32 | 0.26 | 21.98–8.07 | <0.001 |
Peripheral embolism | 0.97 | 0.3 | 1.74–0.54 | 0.914 | 1.94 | 0.32 | 3.61–1.05 | 0.035 |
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Angeli, F.; Bergamaschi, L.; Rinaldi, A.; Paolisso, P.; Armillotta, M.; Stefanizzi, A.; Sansonetti, A.; Amicone, S.; Impellizzeri, A.; Bodega, F.; et al. Sex-Related Disparities in Cardiac Masses: Clinical Features and Outcomes. J. Clin. Med. 2023, 12, 2958. https://doi.org/10.3390/jcm12082958
Angeli F, Bergamaschi L, Rinaldi A, Paolisso P, Armillotta M, Stefanizzi A, Sansonetti A, Amicone S, Impellizzeri A, Bodega F, et al. Sex-Related Disparities in Cardiac Masses: Clinical Features and Outcomes. Journal of Clinical Medicine. 2023; 12(8):2958. https://doi.org/10.3390/jcm12082958
Chicago/Turabian StyleAngeli, Francesco, Luca Bergamaschi, Andrea Rinaldi, Pasquale Paolisso, Matteo Armillotta, Andrea Stefanizzi, Angelo Sansonetti, Sara Amicone, Andrea Impellizzeri, Francesca Bodega, and et al. 2023. "Sex-Related Disparities in Cardiac Masses: Clinical Features and Outcomes" Journal of Clinical Medicine 12, no. 8: 2958. https://doi.org/10.3390/jcm12082958