Cardiac Metastasis: Epidemiology, Pathophysiology, and Clinical Management

Abstract

Cardiac metastases (CMs) are more common than primary cardiac tumors, with autopsy studies reporting incidence rates between 2.3% and 18.3%. Their increasing detection is largely attributed to advances in cancer treatments, which have extended patient survival. CMs may present with diverse clinical manifestations depending on their size, location, and extent of infiltration, although they often remain asymptomatic and are identified only postmortem. Sometimes, they are incidentally discovered during tumor staging or follow-up evaluations. This review explores the incidence, pathophysiology, clinical features, and potential complications of CMs, focusing on their prevalence and characteristics. It highlights the importance of early detection and optimized management strategies to address this growing clinical concern. Further research is essential to elucidate the mechanisms driving CMs and develop effective therapeutic interventions.

Keywords: cardiac tumors; diagnostic method; heart; metastatic tumors.

Figure 1

PRISMA diagram on the selection of included studies.

Figure 2

Pathophysiology of Cardiac Metastases. Metastasis to the heart occurs when tumor cells from a distant organ spread through hematogenous, venous, or lymphatic routes, or by direct extension. In lymphatic spread, cells travel via lymphatic vessels and reach the heart through lymphatic drainage.

Figure 3

Lymphoma with direct myocardial invasion: four-chamber view showing lymphoma invading the entire left ventricular wall (arrows). RV: right ventricle; RA: right atrium; LV: left ventricle; LA: left atrium.

Figure 4

(A,B) A 24-year-old patient diagnosed with Hodgkin lymphoma presented with clinical signs of cardiac tamponade. (A) The image illustrates a parasternal long-axis echocardiographic view, showing a circumferential pericardial effusion with significant accumulation, predominantly along the right ventricular free wall and the posterior wall of the left ventricle. (B) The figure demonstrates a subxiphoid echocardiographic view, highlighting a pericardial effusion exerting compressive effects on the right ventricle, indicative of hemodynamic compromise. RVOT: right ventricular outflow tract; LV: left ventricle; RV: right ventricle.

Figure 5

A contrast-enhanced view of lymphoma metastases: a four-chamber view showing metastasis in the right atrium. The two arrows indicate metastatic masses within the right atrium, which appear as echogenic areas due to contrast enhancement, distinguishing them from potential vascular thrombi. RV: right ventricle; RA: right atrium; LV: left ventricle; LA: left atrium.

Figure 6

A contrast-enhanced CT image showing an endoluminal mass in the left atrium, likely metastatic from renal carcinoma. The black arrow indicates pathological tissue within the left atrium during the arterial phase following iodinated contrast infusion. RA: right atrium; LA: left atrium; LV: left ventricle; RV: right ventricle.

Figure 7

Clinical management of CMs should be individualized, focusing primarily on treating the primary tumor. Surgery is usually not recommended, except in cases of intracavitary metastases causing severe hemodynamic issues or cardiac decompensation, or when solitary cardiac disease exists with a controlled primary tumor and good prognosis. In cases of tamponade, urgent pericardiocentesis or a pericardial window can be life-saving. Arrhythmias due to myocardial infiltration may require medications or interventional procedures. The main goals are symptom relief and quality of life improvement, as curative treatment for cardiac metastasis is generally not feasible. Palliative care is the typical approach.

Figure 8

Future research in cardiac metastasis.