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. 2023 Apr 19;12(8):2958.
doi: 10.3390/jcm12082958.

Sex-Related Disparities in Cardiac Masses: Clinical Features and Outcomes

Francesco Angeli  1   2 , Luca Bergamaschi  1   2 , Andrea Rinaldi  1   2 , Pasquale Paolisso  3 , Matteo Armillotta  1   2 , Andrea Stefanizzi  1   2 , Angelo Sansonetti  1   2 , Sara Amicone  1   2 , Andrea Impellizzeri  1   2 , Francesca Bodega  1   2 , Lisa Canton  1   2 , Nicole Suma  1   2 , Damiano Fedele  1   2 , Davide Bertolini  1   2 , Francesco Pio Tattilo  1   2 , Daniele Cavallo  1   2 , Ornella Di Iuorio  1   2 , Khrystyna Ryabenko  1   2 , Marcello Casuso Alvarez  1   2 , Nazzareno Galiè  1   2 , Alberto Foà  1   2 , Carmine Pizzi  1   2
Affiliations

Sex-Related Disparities in Cardiac Masses: Clinical Features and Outcomes

Francesco Angeli et al. J Clin Med. .

Abstract

Background: Cardiac masses (CM) represent a heterogeneous clinical scenario, and sex-related differences of these patients remain to be established.

Purpose: To evaluate sex-related disparities in CMs regarding clinical presentation and outcomes.

Material and methods: The study cohort included 321 consecutive patients with CM enrolled in our Centre between 2004 and 2022. A definitive diagnosis was achieved by histological examination or, in the case of cardiac thrombi, with radiological evidence of thrombus resolution after anticoagulant treatment. All-cause mortality at follow-up was evaluated. Multivariable regression analysis assessed the potential prognostic disparities between men and women.

Results: Out of 321 patients with CM, 172 (54%) were female. Women were more frequently younger (p = 0.02) than men. Regarding CM histotypes, females were affected by benign masses more frequently (with cardiac myxoma above all), while metastatic tumours were more common in men (p < 0.001). At presentation, peripheral embolism occurred predominantly in women (p = 0.03). Echocardiographic features such as greater dimension, irregular margin, infiltration, sessile mass and immobility were far more common in men. Despite a better overall survival in women, no sex-related differences were observed in the prognosis of benign or malignant masses. In fact, in multivariate analyses, sex was not independently associated with all-cause death. Conversely, age, smoking habit, malignant tumours and peripheral embolism were independent predictors of mortality.

Conclusions: In a large cohort of cardiac masses, a significant sex-related difference in histotype prevalence was found: Benign CMs affected female patients more frequently, while malignant tumours affected predominantly men. Despite better overall survival in women, sex did not influence prognosis in benign and malignant masses.

Keywords: cardiac masses; cardio-oncology; echocardiography; gender medicine.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Kaplan-Meier Survival Curves. (A) Survival in patients with benign neoformations according to gender. (B) Survival in patients with malignant tumours according to gender.
Figure 2
Figure 2
Mortality and peripheral embolism according to gender. Histograms demonstrating the different mortality and peripheral embolism incidence in female and male patients.
See this image and copyright information in PMC

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