title: Pattern and Prognostic Implications of Cardiac Metastases Among Patients With Advanced Systemic Cancer Assessed With Cardiac Magnetic Resonance Imaging.
abstract: Cardiac magnetic resonance (CMR) imaging is well validated for tissue characterization of cardiac masses but has not been applied to study pattern and prognostic implications of cardiac metastases (CMETs) among patients with systemic cancer.
  
  
  
  The population consisted of 60 patients with stage IV cancer (32 patients with CMETs, 28 diagnosis-matched controls) undergoing CMR. CMET was defined as a discrete mass with vascular tissue properties on delayed enhancement CMR. CMET-positive patients and controls had similar clinical characteristics, cardiac geometry, and function (P=NS). Leading cancer types associated with CMET were sarcoma, melanoma, and gastrointestinal. Patients with CMETs had similar distribution of extracardiac metastatic disease compared with controls (organs involved: 3.4±2.0 versus 2.7±1.9, P=0.17). In 94% of patients with CMETs, there were metastases involving ≥1 extracardiac organ (66% lung involvement). CMET location varied (right ventricle 44%, right atrium 19%, left ventricle 28%, left atrium 9%, pericardial 25%); 22% of cases had multichamber involvement. Right-sided chamber involvement was common in hematologic/lymphatic spread (67%); pericardial involvement was common with direct spread (64%). Regarding tissue properties on delayed enhancement CMR, CMETs commonly (59%) demonstrated heterogeneous enhancement (41% diffuse enhancement). Heterogeneous lesions were larger and had increased border irregularity (P<0.05). Survival 6 months post-CMR was numerically lower among patients with CMETs (56% [95% CI 39-74%]) versus stage IV cancer-matched controls (68% [95% CI 50-86%]), although differences between groups were nonsignificant (P=0.42).
  
  
  
  CMETs vary regarding etiology, location, and tissue properties on CMR, highlighting need for comprehensive surveillance of cardiac involvement regardless of cancer origin. Prognosis remains poor with for patients with CMETs, albeit similar to that for stage IV cancer controls matched for cancer etiology.
authors.affiliation: Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Shawn C
authors.initials: SC
authors.lastname: Pun
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Andrew
authors.initials: A
authors.lastname: Plodkowski
authors.affiliation: Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Matasar
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Lakhman
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Darragh F
authors.initials: DF
authors.lastname: Halpenny
authors.affiliation: Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Dipti
authors.initials: D
authors.lastname: Gupta
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Chaya
authors.initials: C
authors.lastname: Moskowitz
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, NY.
authors.forename: Jiwon
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Richard
authors.initials: R
authors.lastname: Steingart
authors.affiliation: Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY Department of Medicine, Weill Cornell Medical College, New York, NY jww2001@med.cornell.edu.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Weinsaft
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000556:secondary; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology; D006258:Head and Neck Neoplasms / Q000473:pathology; D006338:Heart Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000556:secondary; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000556:secondary; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology*; D011379:Prognosis; D012509:Sarcoma / Q000000981:diagnostic imaging* / Q000556:secondary; D012878:Skin Neoplasms / Q000473:pathology; D013318:Stroke Volume; D015996:Survival Rate; D016276:Ventricular Function
keywords: cardiac metastases; cardiac tumor; cardiovascular magnetic resonance; cardio‐oncology; oncology