Factors influencing cardiomegaly and cardiac size changes after endovascular treatment in peripheral arteriovenous malformations

BackgroundAlthough prior studies on peripheral arteriovenous malformations (AVMs) have addressed diagnosis and treatment, the prevalence and risk factors for cardiomegaly remain underexplored.PurposeTo assess the prevalence of cardiomegaly in peripheral AVMs, identify associated factors, and evaluate changes in cardiac size and function following endovascular treatment.Material and MethodsA retrospective review was conducted on 437 patients treated for peripheral AVMs between 2000 and 2022 at a single vascular anomalies center. AVM types were classified according to the Cho-Do angiographic classification. Cardiomegaly was defined as a cardiothoracic ratio (CTR) >0.5 on chest radiographs. Factors associated with cardiomegaly and post-treatment changes in CTR and cardiac function were analyzed.ResultsCardiomegaly was observed in 108/437 (24.7%) patients. Multivariate analysis identified type I/II (vs. III) (<i>P</i> = 0.002), lesion diameter >10 cm (<i>P</i> = 0.013), and bone involvement (<i>P</i> = 0.021) as significant risk factors. Abdominopelvic (<i>P</i> <0.001) and thoracic-neck AVMs (<i>P</i> = 0.018) had higher cardiomegaly prevalence than extremity AVMs. Among the 108 patients with cardiomegaly, 84 underwent follow-up chest radiographs. The median CTR reduction rate was 8.9% (interquartile range [IQR] 4.1-15.8), with a significant decrease (<i>P</i> <0.001). Higher angiographic devascularization was associated with greater CTR reductions (<i>P</i> = 0.013). Echocardiography was selectively performed in patients with suspected cardiac involvement. Among 27 patients with both pre- and post-treatment echocardiography, 44% showed functional improvement.ConclusionAVM type, extent, location, and bone involvement were significant factors influencing cardiomegaly risk. Endovascular treatment was effective in reducing cardiac enlargement and functional improvement was observed in a subset of patients.