Cardiac tumors: imaging findings, clinical correlations and surgical treatment in a 15 years single-center experience

Background: We aimed to: present the clinical and pathological characteristics of cardiac tumors in a single-center series of patients, describe the association of imaging characteristics, clinical presentation and surgical treatment, analyze if second level imaging tests, computed tomography (CT) and cardiac magnentic resonance (CMR), improve the diagnostic accuracy when compared to first-line imaging technique (transthoracic echocardiography,TTE). Methods: We reviewed the medical and surgical records, TTE, CT and CMR examinations of 86 patients with an histological diagnosis of cardiac tumors between 2004 and 2019. Results: The majority were benign tumors (81%) with myxoma accounting for 66% of cases. Among malignancies, metastasis (8%) and primary tumors (10%) were equally recognized. Symptoms at presentation (45% of patients) were associated to larger diameters at TTE. Malignancies were larger (mean diameter 37±14 mm vs 27±13 mm, p<0.01), more frequently exhibited irregular shape (67% vs 17%, p<0.01), frayed or polylobulated surface (73% vs 38%, p=0.035), heterogeneous aspect (67% vs 32%, p=0.012). A maximum diameter >28mm and a minimum diameter >19.5mm emerged as possible cut-off values for the differentiation of benign and malignant tumors. The ability of TTE, CT and CMR features in identifying malingnancies was moderate (diagnostic accuracy of 84%, 81%, 76% respectively). The mean survival time after surgery was 1.6±1.4 years in malignancies and 6.8±4.7 years in benign tumors. Conclusions: Cardiac tumors are rare and mostly benign; their nature and clinics related to TTE appearance. CT and CMR may be used sinergically with TTE. Surgery is curative in benign tumors, survival remains scarce in malignancies