Abstract Background There is limited data on cardiovascular disease (CVD) in patients diagnosed with thymoma. In this retrospective study we sought to assess prevalent and incident CVD in patients diagnosed with thymoma. Methods Using our thymoma registry, 410 patients diagnosed with thymoma between January 1, 2004 to December 31, 2020 were included. Clinical data collected through electronic medical records included: demographics, cancer treatment, CVD risk factors, and prevalent CVD. Incident CVD was collected until August 31, 2024. Our primary outcome was MACE consisting of a new diagnosis of coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), stroke, pacemaker implantation and cardiovascular (CV) death. Cumulative incidence of MACE was estimated using the Gray subdistribution method with non-CV death as a competing risk. Results Amongst the 410 patients (median age 57 years (Q1-Q3 46-67), 50% female), hypertension was the most prevalent baseline CV risk factor (n=121 29.5%). Previous CVD history included CAD in 16 (3.9%), HF in 5 (1.2%), AF in 15 (3.7%) and stroke in 5 (1.2%) patients. Ninety-nine (24%) patients had baseline echocardiogram. Treatment for first diagnosis of thymoma included surgery in 366 (89%) patients. Mediastinal radiation was given in 199 (48%) patients, at a median dose of 46 Gy (IQR 40-50 Gy). Chemotherapy was used in 107 (26%) patients, of whom 37 (9%) received anthracyclines. Recurrent/ongoing disease was documented in 116 (28%) patients; 25 (22%) of whom subsequently received mediastinal radiation and 22 (19%) received anthracyclines. Only 146 (36%) patients had an echocardiogram during follow-up period. Over a median follow-up time of 6.8 years (IQR 4.5-11.1), death occurred in 94 (33%) patients, of whom 6 (6.4%) were attributed to CVD. Thirty-nine (9.5%) patients developed HF, 26 (6%) had obstructive CAD, 25 (6.1%) with AF, and 6 (1.5%) patients had pacemaker implantation. The cumulative incidence of MACE over the follow-up period was 40.4% (95% CI: 30.2-53.9%]) (Figure 1). Patients who experienced MACE were older at thymoma diagnosis (61 vs. 56 years, p=0.03) and were more likely to be male (59% vs. 47%, p=0.05), compared to those without. There were no significant differences in the prevalence of baseline smoking, HTN, DM, CAD, HF, AF and stroke. Greater proportion of patients with MACE received mediastinal radiation (80% vs. 44%, p0.001) and/or anthracyclines (21% vs. 12%, p=0.031). The hazard ratio (HR) for MACE was 2.5 (95% CI 1.39-4.47, p=0.002) with mediastinal radiation alone, and 8.6 (4.24-17.83, p0.001) when both radiation and anthracyclines were used. Conclusion Approximately 1 in 5 patients developed CV events after diagnosis of thymoma. Use of mediastinal radiation with or without anthracyclines increase the risk. Despite these risks, cardiovascular monitoring was limited. There is a need to establish CV risk assessment and surveillance, in patients diagnosed with thymoma.
Agmon et al. (Fri,) studied this question.