Echocardiographic characteristics of primary malignant pericardial mesothelioma and outcomes analysis: a retrospective study

Our plain-English summary of Echocardiographic characteristics of primary malignant pericardial mesothelioma and outcomes analysis: a retrospective study, by L. Kong, Z. Li, J. Wang, et al (Cardiovascular Ultrasound, 2018).

The study

• Authors: L. Kong, Z. Li, J. Wang, X. Lv
• Journal: Cardiovascular Ultrasound
• Published: 2018;16(1):7
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Little is known about the echocardiographic characteristics of primary malignant pericardial mesothelioma (PPM) due to its rarity. The aim of this study was to explore the sex-specific echocardiographic patterns of PPM and risk factors for in-hospital mortality.

Methods: A retrospective information retrieval was conducted for cases of PPM reported from China during 1981 and 2015. The diagnosis was made by histopathological examinations and only cases with echocardiographic descriptions were included. Data on the clinical and echocardiographic findings were collected. Difference in clinical, sex-specific echocardiographic characteristics and findings across different time periods were assessed. Logistic regression analysis was performed to explore echocardiographic risk factors for in-hospital mortality.

Results: A total of 64 patients with PPM were included, with a mean age of 39.2 ± 15.6 years and minor male dominance (40, 62.5%). The most common echocardiographic presentations were pericardial effusion (55, 85.9%), pericardial masses (36.4%) and thickening (17.3%), respectively. The positive rate of pericardiocentesis was only 20.9%. Six patients (15.4%) died among 39 cases reporting in-hospital outcome. Logistics analysis identified no clinical or echocardiographic parameters associated with in-hospital mortality (all P > 0.05).

Conclusions: The echocardiographic signs of PPM are basically nonspecific with massive pericardial effusion as the most common sign, although no echocardiographic gender differences or association with in-hospital mortality could be identified.

In plain English

This retrospective analysis pooled published cases (case reports, series and conference papers) of primary malignant pericardial mesothelioma, a cancer of the sac around the heart. The authors searched Chinese databases and PubMed for tissue-confirmed cases from mainland China, 1981 to 2015. They included 64 patients from 49 articles with echocardiogram (heart ultrasound) descriptions; 40 were male. Fluid around the heart was the most common ultrasound finding (55 of 64 patients), often massive. Of 43 patients who had the fluid drained, cancer cells were found in the fluid in 9 (20.9%). In patients who also had other tests, ultrasound showed pericardial thickening in 9 of 52, against 33 of 52 on the other tests. It showed masses in 20 of 55, against 32 of 55. Of 39 patients with reported hospital outcomes, 6 (15.4%) died. No clinical or ultrasound feature was significantly associated with death; the authors said small numbers of patients and deaths may explain this. Men and women showed no statistically significant ultrasound differences. The authors concluded that the ultrasound signs were basically nonspecific. They stated that the link between asbestos exposure and this cancer could not be determined.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective analysis of previously published case reports, case series and conference papers (pooled literature review of individual cases)
• Who was studied: 64 patients with histopathologically diagnosed primary malignant pericardial mesothelioma, from 49 articles reporting cases from mainland China between January 1981 and December 2015; 40 male (62.5%) and 24 female; ages 2 to 77 years
• Exposure: Asbestos exposure was not studied. The study examined echocardiographic findings. The authors stated that the association between asbestos exposure and pericardial mesothelioma could not be determined.
• Main results:
  • Pericardial effusion was the most frequent echocardiographic finding, in 55 of 64 patients (85.9%); it was massive in 43 patients.
  • Of 43 patients who had pericardiocentesis, malignant mesothelial cells were detected in the fluid in 9 (20.9%).
  • Among 52 patients assessable by both echocardiography and other examinations, pericardial wall thickening was found in 33/52 (63.5%) on non-echo exams but in only 9/52 (17.3%) on echocardiography.
  • Among 55 patients assessable by non-echo examinations, pericardial masses were recorded in 32 (58.2%), while echocardiography was positive in 20 (36.4%).
  • No statistically significant difference in echocardiographic signs was found between male and female patients or across time periods.
  • Of 39 cases reporting in-hospital outcome, 6 (15.4%) died.
  • Logistic regression found no statistically significant clinical or echocardiographic predictor of in-hospital mortality. The authors noted this was possibly limited by the small population and small number of deaths.
  • In 44 patients with detailed thoracotomy or autopsy descriptions, 20 (45.4%) had adhesion of malignant mesothelial tissue to the ventricular wall. Only one of these 20 had wall motion hypokinesis reported on echocardiography.
• The authors' conclusion: The authors concluded that massive pericardial effusion is the most common echocardiographic sign, but that the signs are generally nonspecific, with no gender-specific difference or association with in-hospital mortality. They added that histopathological examination is needed to confirm the diagnosis.
• Limitations the authors state:
  • Because the disease is so rare, only a retrospective analysis of a limited number of patients was possible.
  • Selection bias inherent to retrospective study, and incomplete information for many patients.
  • Including only patients with echocardiographic data might limit how far the results can be applied to other patients.
  • The small population and small number of deaths may have prevented identification of prognostic factors.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Pericardial Effusion, Pericardial, Pericardiocentesis.

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