Characteristics Of Cardiac Myxoma With Constitutional Signs: A Multicenter Study In Japan

Background: A relationship between constitutional signs in patients with cardiac myxoma and interleukin-6 has been noted. However, there is little information about characteristics of cardiac myxomas associated with constitutional signs.Hypothesis: The objective of this study was to clarify the characteristics of myxoma patients who had constitutional signs.Methods: Questionnaires were sent to cardiology or cardiovascular surgery divisions at university hospitals throughout Japan. Constitutional signs were considered present when a patient had fever, weight loss, or elevations of C-reactive protein or gammaglobulin. In addition, interleukin-6 concentrations were evaluated in some patients.Results: Data were obtained in 249 patients with primary cardiac tumors (204 myxomas, 15 other primary benign tumors, and 30 primary malignant tumors), confirmed histologically between 1993 and 1996. Fever and weight loss were observed in 15 and 6% of patients with myxoma, respectively, while C-reactive protein and gammaglobulin were increased in 39 and 21%, respectively. This amounted to a prevalence of constitutional signs in 49%. All constitutional signs disappeared after tumor resection. Age, gender, tumor site, and frequency of thrombosis did not differ between patients with and without constitutional signs. Tumors associated with constitutional signs were significantly more likely to be large, multiple, or recurrent than those unassociated with constitutional signs.Conclusions: Constitutional signs are present in about half of patients with myxoma. Large or multicentric tumors are likely to induce constitutional signs, which are reversible upon resection. These might suggest that constitutional signs result when interleukin-6 concentrations exceed a certain threshold.