Clinical and Echocardiographic Insights Into Right Heart Masses: A Retrospective Study in China (2010–2023)

ABSTRACT Background This study aimed to analyze the clinical and echocardiographic characteristics, pathological profiles, and outcomes of right heart masses, and to explore the role of echocardiography in the evaluation of these masses. Methods We retrospectively analyzed 171 patients with echocardiographically diagnosed and pathologically confirmed right heart masses from two centers (2010–2023). Data on clinical presentation, echocardiographic features, pathology, and follow‐up were collected. Survival analysis using Kaplan–Meier curves and multivariable Cox regression was performed to identify prognostic factors. Results Among 171 patients, 114 had primary cardiac tumors (82 benign, 30 malignant, and 2 of uncertain biological behavior), 41 had metastatic tumors, and 16 had thrombi or other lesions. Myxomas (63.4%) and angiosarcomas (63.3%) were the most common benign and malignant tumors, respectively. Patients with benign tumors had significantly better survival than those with malignant tumors, metastases, or thrombi (all p < 0.01). In the primary tumor subgroup ( n = 112), better survival was associated with pedunculated morphology, well‐defined margins, high mobility, and absence of metastasis (all p < 0.01). Multivariable analysis identified malignant tumor type (HR = 10.072, p < 0.001; reference: benign tumor), absence of a pedicle (HR = 2.610, p = 0.044; reference: presence of a pedicle), and presence of metastasis (HR = 3.210, p = 0.025; reference: no metastasis) as independent prognostic factors. The median follow‐up was 26 months, with a recurrence rate of 4.7% and overall mortality of 35.7%. Conclusion Tumor type, pedicle presence, and metastasis are key prognostic factors for primary right heart tumors. Echocardiography is essential for diagnosis and differential diagnosis of right heart masses.