Key result
Cardiac myxomas carry a ~20% pooled embolic prevalence, predominantly involving cerebral events.
Why the study?
Although previous reviews examined clinical features and embolic risk factors of cardiac myxomas, the frequency, anatomical distribution, management, and outcomes of myxoma-related embolisation had not been comprehensively synthesised.
Meta-Analysis (n=4,964)
Effect estimate: Prevalence 19.7% (95% CI 16.7-23.1)
Embolic complications occur in nearly 20% of patients with cardiac myxoma—predominantly affecting the cerebral circulation—and are more consistently associated with villous surface morphology and high tumour mobility than tumour size.
High embolic risk in cardiac myxoma supports morphology- and mobility-guided surgical urgency; extends observational data with pooled prevalence from 4964 patients.
Objectives Cardiac myxomas are the most common benign primary cardiac tumours and embolise, causing stroke, acute coronary syndrome, limb ischaemia, and visceral infarction. Although previous reviews examined clinical features and embolic risk factors, the frequency, anatomical distribution, management, and outcomes of myxoma-related embolisation have not been comprehensively synthesised. Methods We searched MEDLINE, Embase, Scopus, CINAHL, the Cochrane Library, and PubMed from inception to February 2026 for observational studies reporting embolic complications of confirmed cardiac myxoma; small (≤10-patient) and pre-2000 case series were excluded. Random-effects meta-analyses of proportions estimated patient-level embolic prevalence and event-level anatomical distribution. Results Across 47 studies (4,964 patients), pooled embolic prevalence was 19.7% (95% CI 16.7–23.1; I²=75.4%, 95% CI 62.8-87.5). Cerebral events predominated (75.6%), followed by peripheral limb (17.0%). Pooled early mortality was 1.9% (95% CI 1.3–2.7). Villous morphology and high tumour mobility were more associated with embolisation than size. Recurrence was uncommon (crude rate 2.0%) and mainly in familial disease or Carney complex. Conclusion Embolism is common and predominantly cerebral. Villous surface and tumour mobility were more consistently associated with embolisation than size and may inform the urgency of resection. However, evidence is retrospective; the optimal timing after embolic presentation remains undefined, and prospective validation is required.
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Dahil et al. (2026) conducted a meta-analysis in Cardiac myxoma (n=4,964). Cardiac myxoma (including villous morphology and high tumour mobility) was evaluated on Patient-level embolic prevalence and event-level anatomical distribution (Prevalence 19.7%, 95% CI 16.7-23.1). Cardiac myxomas had a 19.7% (95% CI 16.7-23.1) pooled embolic prevalence, predominantly cerebral (75.6%), with 1.9% early mortality.
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