心脏乳头状纤维瘤与脑血管事件:系统回顾

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
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引用次数: 0

摘要

背景心脏乳头状纤维母细胞瘤(CPF)是一种具有栓塞潜能的心内膜良性肿瘤。本文是一篇系统性综述,旨在确定以中风或短暂性脑缺血发作(TIA)为症状的 CPF 患者的临床概况、诊断、肿瘤特征和治疗方式。方法本系统性综述使用 PubMed 和 Embase 数据库,包括病例报告和/或系列研究以及观察性研究(检索期截至 2022 年 4 月)。结果 从 133 份病例报告和 11 份系列病例报告中共确定了 161 个病例。患者平均年龄为 54.8 岁,46.6% 为男性。TIA 和脑卒中分别占 32.3% 和 67.8%。最常见的中风部位是多个脑部部位(36.6%)。肿瘤的平均大小为 11.8 毫米。大多数肿瘤位于左侧(98.7%)。二尖瓣是受累最多的瓣膜(38.9%),前叶是最常见的部位(61.3%)。91.4%的肿瘤可独立移动;10.6%经胸超声心动图漏诊的肿瘤在经食道超声心动图检查中被发现。分别有 87.9% 和 12.1% 的病例采用了抗血小板和抗凝治疗。分别有66.7%、16.7%和16.7%的患者接受了单纯切除术、瓣膜修复术和瓣膜置换术。逻辑回归模型显示,年龄是唯一重要的预测因素;随着年龄的增加,复发性脑血管事件的对数增加。与经胸超声心动图相比,经食道超声心动图是识别 CPF 的更好的成像工具。尽管 CPF 的治疗共识仍存在争议,但手术切除是治疗表现为卒中或 TIA 的左侧 CPF 的主要方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cardiac Papillary Fibroelastoma and Cerebrovascular Events: A Systematic Review

Background

Cardiac papillary fibroelastomas (CPFs) are benign endocardial tumours with embolic potential. This article is a systematic review to identify the clinical profile, diagnosis, tumour characteristics, and treatment modalities in patients with CPF presenting with stroke or transient ischemic attack (TIA).

Methods

This systematic review was conducted using the PubMed and Embase databases, including case reports and/or series and observational studies (for a search period of up until April 2022). A descriptive summary of case reports and/or series, and a narrative summary of observational studies, were completed.

Results

A total of 161 cases were identified from 133 case reports and 11 case series. The mean age of patients was 54.8 years, and 46.6% were male. TIA and stroke were reported in 32.3% and 67.8%, respectively. The most common stroke territory was multiple brain sites (36.6%). The mean tumour size was 11.8 mm. Most of the tumours were left-sided (98.7%). The mitral valve was the most involved valve (38.9%), with the anterior leaflet being the commonest site (61.3%). A total of 91.4% of tumours were independently mobile; 10.6% of tumours missed by transthoracic echocardiography were identified on transesophageal echocardiography. Antiplatelet and anticoagulation treatment were used in 87.9% and 12.1% of cases, respectively. Simple excision, valve repair, and valve replacement were performed in 66.7%, 16.7%, and 16.7%, respectively. The logistic regression model revealed that age was the only significant predictor; an increase in the log-odds of recurrent cerebrovascular events occurred with increasing age.

Conclusions

CPFs are a differential diagnosis of cryptogenic stroke, especially if the initial workup for stroke is negative. Transesophageal echocardiography serves as a better imaging tool, compared to transthoracic echocardiography, in identifying CPF. Although the consensus for CPF management remains controversial, surgical excision is the primary approach for left-sided CPF presenting as stroke or TIA.
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来源期刊
CJC Open
CJC Open Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
发文量
143
审稿时长
60 days
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