Spectrum of electrocardiographic abnormalities in a large cohort of cardiac masses

Francesco Angeli; Luca Bergamaschi; Pasquale Paolisso; Matteo Armillotta; Angelo Sansonetti; Andrea Stefanizzi; Lisa Canton; Francesca Bodega; Nicole Suma; Sara Amicone; Damiano Fedele; Davide Bertolini; Andrea Impellizzeri; Francesco Pio Tattilo; Daniele Cavallo; Ornella Di Iuorio; Khrystyna Ryabenko; Virginia Marinelli; Marcello Casuso Alvarez; Rebecca Belà; Leonardo Luca Bavuso; Claudio Asta; Mariachiara Ciarlantini; Giuseppe Pastore; Andrea Rinaldi; Paola Rucci; Alberto Foà; Carmine Pizzi

doi:10.1016/j.hrthm.2024.06.035

Spectrum of electrocardiographic abnormalities in a large cohort of cardiac masses

Heart Rhythm. 2024 Jun 21:S1547-5271(24)02809-1. doi: 10.1016/j.hrthm.2024.06.035. Online ahead of print.

Authors

Francesco Angeli¹, Luca Bergamaschi¹, Pasquale Paolisso², Matteo Armillotta¹, Angelo Sansonetti¹, Andrea Stefanizzi¹, Lisa Canton¹, Francesca Bodega¹, Nicole Suma¹, Sara Amicone¹, Damiano Fedele¹, Davide Bertolini¹, Andrea Impellizzeri¹, Francesco Pio Tattilo¹, Daniele Cavallo¹, Ornella Di Iuorio¹, Khrystyna Ryabenko¹, Virginia Marinelli¹, Marcello Casuso Alvarez¹, Rebecca Belà¹, Leonardo Luca Bavuso¹, Claudio Asta¹, Mariachiara Ciarlantini¹, Giuseppe Pastore¹, Andrea Rinaldi¹, Paola Rucci³, Alberto Foà¹, Carmine Pizzi⁴

Affiliations

¹ Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Bologna, Italy.
² Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant'Ambrogio Hospital, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
³ Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
⁴ Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Bologna, Italy. Electronic address: carmine.pizzi@unibo.it.

PMID: 38909718
DOI: 10.1016/j.hrthm.2024.06.035

Abstract

Background: Cardiac masses represent a heterogeneous clinical scenario. Potential electrocardiographic (ECG) red flags of malignancy remain to be investigated.

Objectives: 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).

Conclusion: ECG frequently is abnormal in cases of malignant cardiac tumors. Some specific ECG changes are strongly suggestive for malignancy and type of infiltration.

Keywords: Arrhythmia; Benign tumor; Cardiac tumor; Electrocardiogram; Malignant tumor.