Angeli Francesco, Bergamaschi Luca, Paolisso Pasquale, Armillotta Matteo, Sansonetti Angelo, Stefanizzi Andrea, Canton Lisa, Bodega Francesca, Suma Nicole, Amicone Sara, Fedele Damiano, Bertolini Davide, Impellizzeri Andrea, Tattilo Francesco Pio, Cavallo Daniele, Di Iuorio Ornella, Ryabenko Khrystyna, Marinelli Virginia, Casuso Alvarez Marcello, Belà Rebecca, Bavuso Leonardo Luca, Asta Claudio, Ciarlantini Mariachiara, Pastore Giuseppe, Rinaldi Andrea, Rucci Paola, Foà Alberto, Pizzi Carmine
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.
Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant'Ambrogio Hospital, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
Heart Rhythm. 2025 Jan;22(1):240-249. doi: 10.1016/j.hrthm.2024.06.035. Epub 2024 Jun 21.
Cardiac masses represent a heterogeneous clinical scenario. Potential electrocardiographic (ECG) red flags of malignancy remain to be investigated.
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.
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.
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).
ECG frequently is abnormal in cases of malignant cardiac tumors. Some specific ECG changes are strongly suggestive for malignancy and type of infiltration.
心脏肿物代表了一种异质性的临床情况。恶性肿瘤潜在的心电图（ECG）警示信号仍有待研究。
本研究的目的是描述一大群心脏肿物患者的心电图异常谱，并评估提示恶性肿瘤的潜在警示信号。
这是一项对博洛尼亚大学医院322例连续的有心脏肿物且有可用心电图的患者进行的观察性队列研究。所有肿物均通过组织学检查确诊，对于心脏血栓，则在适当的抗凝治疗后通过影像学消退确诊。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素。评估随访时的全因死亡率。
322例患者中，98例（30.4%）患有恶性肿瘤。与良性肿物患者相比，恶性肿瘤患者在就诊时表现出更高的心率、电轴右偏、更大的去极化、复极异常和缓慢性心律失常。关于特定的心电图特征，入院时较高的心率（P = 0.014）、缓慢性心律失常（P = 0.009）、缺血样复极异常（ST段偏移，包括压低和抬高，以及T波倒置；P < 0.001）、低电压（P = 0.001）和电轴右偏（P = 0.025）被确定为恶性肿瘤的独立预测因素。考虑到这些特定的心电图改变，以恶性肿瘤为导向的心电图与随访时较高的死亡率相关（中位时间20.7个月）。
恶性心脏肿瘤患者的心电图常出现异常。一些特定的心电图变化强烈提示恶性肿瘤及其浸润类型。
