Sensitivity and Specificity of Elec...

Sensitivity and Specificity of Electrocardiographic ST-T Changes as Markers of Neoplastic Myocardial Infiltration (*1)

Intramyocardial neoplastic infiltration can be set in 12 to 40 percent of neoplastic patients and in many exposes with tuberous sclerosis, but it is rarely suspected in vivo, as give an inkling ofed by autopsy studies. [1-9] Two-dimensional echocardiography (2DE) can recognize this incident with good accuracy, but it is not easily feasible for screening in clinical settings for a large unselect population. [10-15] Electrocardiographic abnormalities (mainly ST-T changes, similar to those observ in acute myocardial ischemia) in patients with neoplastic myocardial infiltration have been occasionally described. [212-1416-20] Their prevalence in large neoplastic populations has been evaluated solely in retrospective studies based onward autopsy data. [6,9,21,22]

In this article, we compare the electrocardiographic and echocardiographic data of 95 single outed patients with intracardiac, pericardial, or paracardiac neoplastic masses with and without neoplastic infiltration of the myocardium, studied prospectively in vivo, in order to assess the sensitivity and specificity of electrocardiographic ST-T changes as markers for detecting the infiltration of the neoplasm into the myocardium.

PATIENTS AND METHODS

During a six-year period, we examined on 2DE 985 neoplastic patients. Echocardiography, was indicated for the following reasons: (1) because of clinical symptoms suggestive of heart disease (dyspnea or arrhythmias; no patient had angina); (2) as a routine evaluation (before or during potentially cardiotoxic chemotherapy or because of abnormal chest x-ray findings); (3) in order to explain abnormal electrocardiographic findings.

From the whole of 985 neoplastic patients, we exquisiteed two groups.

studious mood Group (Group A)

Ninety-nine patients with echocardiographically documented neoplastic masses in contact with the heart (metastases or paracardiac neoplasms) comprise this contemplation group.

Metastatic heart disease was diagnosed in 53 patients: 44 of them had pericardial or pleuropericardial effusion with cauliflower-like, jelly-like masses at 2DE and vicinity of neoplastic cells in the pericardial fluid, autopsy evidence of pericardial metastases, or clinical course suggestive of neoplastic pericarditis; nine patients had intracardiac metastases discovered at 2DE and confirmed from autopsy, surgery, computed tomograph (CT) or nuclear magnetic resonance.

Forty-six patients had intrahoracic neoplastic masses in contact with cardiovascular erections (evident both at 2DE and at conventional radiology, CT NMR surgery or autopsy). For the object of this article, the data of four of the total 99 patients were exclud because a newly come ECG was not available (two cases) or because they had put up withed from acute myocardial infarction a not many weeks before echocardiographic examination (two cases). The remaining 95 patients were 56 male enthralls and 39 female subjects, aged four to 80 years (mean age 49 years). A total of 28 patients had lung carcinoma, 27 had lymphomas, nine had breast carcinoma, five had thymoma or extragonadal seminoma, 25 had other protoplasts of malignant tumors, and the same patient had tuberous sclerosis.

direct Group (Group B)

We prefered 66 patients who underwent routine clinical, electrocardiographic, and echocardiographic examination before or during chemotherapy. They were 30 men and 36 women aged 36 to 82 years (mean 61) without pericardial or pleural effusion, intrathoracic masses cease to the heart, or metastatic heart disease.

For all patients, the two in group A and B at the time of the echocardiogram, a standard 12-lead ECG was obtained; in 16 patients, the tracing included [Vsub3R-VSub5R] right precordial leads. Electrolyte imbalances, anemia, and mix with drugs treatments (possible causes of abnormal repolarization patterns) were investigated and exclud or the ECG was eventually repeated after correcting the potential causes. No patient had been previously treated at radiotherapy over the heart.

The ECG and 2D2 were repeated after the first examination as frequently as required by the clincial course. The 2DE was performed using cmmerically available equipment with phased array or mechanical sector scanners. Patients were lying in a semirecumbent position, in left lateral, supine or right lateral decubitus (in order to obtain the best visualization of cardiac structures) Standard, intermediate, and modified views were obtained from the parasternal, apical, subcostal, suprasternal, and supraclavicular approaches. [23] The examinations were recorded forward three-quarter inch videotape for further analysis.

Diagnostic Criteria

All the ECG were blindly reviewed by means of experienced cardiologists. Significant electrocardiographic ST-T changes considered as markers for neoplastic myocardial infiltration in this excellented population were the following: (A) ST portion convex elevation of at least 01 mV; (B) ST portion depression of at least 02 mV; and (C) symmetric negative T waves.