The spectrum of ECG abnormalities in a large cohort of histologically proven cardiac tumors

Abstract Background Cardiac tumors represent a heterogeneous clinical scenario. The role of ECG in the diagnostic work-up remains to be investigated. Objectives To describe the spectrum of electrocardiographic abnormalities in a large cohort of histologically proven cardiac tumors and to evaluate potential red flags of malignancy. Material and Methods 247 consecutive patients with histologically proven cardiac tumors and available ECG at Bologna University Hospital were enrolled. All ECGs were independently analyzed off-line using a manual caliper by two experienced cardiologists who were blinded to clinical information and histological results. In case of disagreements, a third consensus re-assessment was performed to resolve any discrepancies. Multivariable regression analysis was used to assess potential predictors of malignancy among electrocardiographic abnormalities. Results Of 247 patients, 98 (39.7%) had malignant tumors. Compared with patients with benign tumors, those with malignant tumors exhibited a higher heart rate, right axis deviation, greater depolarization, repolarization abnormalities and bradyarrhythmia at presentation. Regarding specific ECG features, a higher heart rate on admission (p=0.001), bradyarrhythmias (p=0.01), ischemic-like repolarization abnormalities (ST-segment deviation, both depression and elevation, and negative T-wave; p<0.001) and low voltages (p=0.005) were identified as independent predictors of malignancy. Conclusion ECG is frequently abnormal in case of malignant cardiac tumors. Some specific electrocardiographic changes could have a supportive role in the diagnostic workup of patients with cardiac tumors by increasing the clinical suspicion of malignancy.ECG Tumors