Edoute Y, Haim N, Rinkevich D, Brenner B, Reisner S A
Department of Internal Medicine C, Rambam Medical Center, Haifa, Israel.
Am J Med. 1997 Mar;102(3):252-8. doi: 10.1016/S0002-9343(96)00457-3.
Nonbacterial thrombotic endocarditis can complicate various malignancies and may cause morbidity and mortality mainly as a result of systemic embolism. The antemortem diagnosis of nonbacterial thrombotic endocarditis is rare. The purpose of our study was to assess the frequency, echocardiographic characteristics, and clinical correlation of nonbacterial thrombotic endocarditis in cancer patients.
A prospective echocardiographic screening of 200 nonselected ambulatory patients with solid tumors was performed. Patients were evaluated for evidence of thromboembolic events and for plasma D-dimer levels. A cohort of 100 consecutive patients without overt heart disease referred to echocardiography for the detection of an occult arterial embolic source served as a control group. It consisted of 52 males and 48 females, median age 60 years.
The study group included 87 women and 113 men, median age 64 years (range 21 to 91). The frequent malignancies were lymphoma (26%), carcinoma of the gastrointestinal tract (20%), and carcinoma of the lung (16%). Cardiac valvular vegetations were found in 38 patients (19%) compared with only in 2 patients in the control group (2%, P < 0.001). Vegetations were found on the mitral or on the aortic valve in 19 and 18 patients, respectively. Isolated tricuspid valve vegetation was found in 1 patient. Valvular lesions were mostly common in patients with carcinoma of the pancreas (3 of 6, 50%), carcinoma of the lung (9 of 32, 28%), and lymphoma (10 of 52, 19%). Thromboembolism was diagnosed in 22 (11%) patients (12 deep vein thrombosis, 4 emboli to extremities, 2 cerebrovascular accidents, and 4 "silent" segmental left ventricular wall motion abnormalities on echocardiography). Thromboembolism was noticed in 9 of 38 patients (24%) with vegetations compared with 13 of 162 patients without vegetations (8%; P = 0.013). Plasma D-dimer level was examined in a subgroup of 170 patients. D-dimer level was increased in 19 of 21 patients (90%) with thromboembolism compared with 76 of 149 patients without thromboembolism (51%; P = 0.001).
This study demonstrated a high prevalence of cardiac valvular lesions in patients with solid tumors. Vegetations were associated with thromboembolism. Plasma D-dimer level was significantly increased in patients with thromboembolism.
非细菌性血栓性心内膜炎可使各种恶性肿瘤病情复杂化，主要由于系统性栓塞可导致发病和死亡。非细菌性血栓性心内膜炎的生前诊断很少见。我们研究的目的是评估癌症患者中非细菌性血栓性心内膜炎的发生率、超声心动图特征及临床相关性。
对200例未经过挑选的实体瘤门诊患者进行前瞻性超声心动图筛查。评估患者是否有血栓栓塞事件的证据以及血浆D-二聚体水平。一组连续100例无明显心脏病的患者因检测隐匿性动脉栓塞源而行超声心动图检查作为对照组。该组包括52例男性和48例女性，中位年龄60岁。
研究组包括87例女性和113例男性，中位年龄64岁（范围21至91岁）。常见的恶性肿瘤为淋巴瘤（26%）、胃肠道癌（20%）和肺癌（16%）。38例患者（19%）发现心脏瓣膜赘生物，而对照组仅2例患者（2%）发现（P<0.001）。分别有19例和18例患者在二尖瓣或主动脉瓣发现赘生物。1例患者发现孤立的三尖瓣赘生物。瓣膜病变在胰腺癌患者（6例中的3例，50%）、肺癌患者（32例中的9例，28%）和淋巴瘤患者（52例中的10例，19%）中最为常见。22例（11%）患者诊断为血栓栓塞（12例深静脉血栓形成、4例肢体栓塞、2例脑血管意外以及4例超声心动图显示“无症状”的节段性左心室壁运动异常）。38例有赘生物的患者中有9例（24%）发现血栓栓塞，而162例无赘生物的患者中有13例（8%）发现血栓栓塞（P=0.013）。对170例患者的亚组检测了血浆D-二聚体水平。21例有血栓栓塞的患者中有19例（90%）D-二聚体水平升高，而149例无血栓栓塞的患者中有76例（51%）升高（P=0.001）。
本研究表明实体瘤患者中心脏瓣膜病变的患病率很高。赘生物与血栓栓塞有关。血栓栓塞患者的血浆D-二聚体水平显著升高。
