Risk Factors Analysis For Embolism In Patients With Cardiac Myxoma

Objectives: To investigate the risk factors of preoperative embolism in patients with cardiac myxoma using TTE combined with laboratory examination,to improve the level of diagnosis and treatment,to prevent the occurrence of cardiac myxoma related embolism events,and to improve the prognosis of patients.Methods: Using retrospective analysis method,185 patients with cardiac myxoma who were operated the surgery of cardiac myxoma excision in the First Affiliated Hospital of Guangxi Medical University during January 2003 and January 2018 were enrolled.Their pathological results were confirmed after surgery.According to whether or not having embolism events occurred before surgery,the patients are divided into embolic group(27 cases)and non-embolic group(158 cases).In this study,basic datas(gender,age,BMI,clinical complications),tumor of echocardiographic characteristics(shape,size,number,the characteristics of internal echo,mobility,base width,attached location),hematological parameters(the levels of white blood cells and platelet count,fibrinogen)are compared between the two groups.Logistic regression analysis was used to investigate the risk factors of preoperative vascular embolism in patients with cardiac myxoma.Results:(1)There were no significant difference in the distribution of gender,age,BMI and preoperative clinical complications between the embolic group and the non-embolic group(P > 0.05).(2)There were no significant difference in LVEF,valvular dysfunction,pulmonary hypertension,and size,number,internal echo of the tumor between the both groups,while the difference in shape,mobility,basal width,and attached location of the myxoma were statistically significant(P < 0.05).(3)No significant relationship were found between with the levels of white blood cells,platelet count and other factors in hematologic parameters(P >0.05),while the increased of plasma fibrinogen level was associated with increased risk of embolism in cardiac myxoma(P < 0.05).(4)The results of multiple factors logistic regression analysis show that the basal width [OR=1.152,95 % CI(0.761-1.743),P=0.013],attached position [OR= 2.534,95%CI(1.031-6.226),P=0.043]and preoperative FIB>5g/L [OR=2.877,95%CI(1.125-7.357),P=0.027] are the independent risk factors for embolism in patients with cardiac myxoma.Conclusion: The shape,mobility,basal width,attached position,and plasma fibrinogen levels of tumor,are closely associated with preoperative embolic events in patients with cardiac myxoma.The basal width,attached position,and FIB > 5g/L are the independent risk factors for preoperative embolism in patients with cardiac myxoma.Once diagnosed,patients should undergo surgical excision as soon as possible,with caution operated to avoid the occurrence of complications such as vascular embolism and sudden death.