Combining clinical and morphological parameters to predict embolic events in patients with cardiac masses
L Toni, T Manaresi, A Maida, M Basile, N Vasumini, M Di Leo, M Casuso Alvarez, M Moretti, P Stradaioli, S Amicone, L Canton, M Armillotta, D Cavallo, F Angeli, C PizziAbstract
Background
Cardiac masses (CMs) are rare but clinically relevant conditions, frequently complicated by systemic or pulmonary embolism. The CHA2DS2-VASc and CHA2DS2-VA scores, established for thromboembolic risk assessment in atrial fibrillation, have not been specifically evaluated in patients with CMs and reliable tools for predicting embolic events in this setting are lacking.
Purpose
To investigate the predictive value of CHA2DS2-VASc and CHA2DS2-VA scores combined with echocardiographic features for embolic events at presentation in patients with cardiac masses and to develop an integrated predictive score for clinical stratification.
Methods
We retrospectively analyzed 238 consecutive patients with histologically confirmed CMs evaluated between January 2004 and October 2024. Patients with atrial fibrillation, cardiac thrombi, or ongoing anticoagulation were excluded. Clinical, laboratory, and comprehensive echocardiographic data were collected. Embolic events were confirmed by guideline-recommended imaging. Multivariable logistic regression identified independent predictors of embolism, and a weighted score was derived from regression coefficients. Prognostic impact was assessed with Kaplan–Meier and Cox regression analyses.
Results
Fifty-two patients (21.8%) presented with embolic events. Independent predictors were CHA2DS2-VA ≥3 (OR 10.67, 95% CI 4.05–28.12, p<0.001), irregular margins (OR 25.80, 95% CI 8.74–76.10, p<0.001), mobility (OR 11.91, 95% CI 3.93–36.09, p<0.001), and non-septal implantation (OR 1.54, 95% CI 1.61–13.48, p=0.004). The derived score (range 0–7) showed excellent discrimination (AUC 0.932, 95% CI 0.900–0.963); a cut-off ≥4 provided 85% sensitivity and 85% specificity. Higher scores were independently associated with increased all-cause mortality (HR 1.81, 95% CI 1.02–3.23, p=0.038). Inclusion of female sex did not significantly improve predictive performance.
Conclusions
A novel composite score integrating CHA2DS2-VA and key echocardiographic features accurately predicts embolic events at presentation and prognosis in patients with cardiac masses, potentially supporting individualized management strategies.KMAUC