Thymoma cancer diagnosis intrinsically increases cardiovascular risk: an echocardiographic study individuating subtle reduction in biventricular systolic function

Abstract Background Thymoma is a rare malignancy, with affected patients frequently exhibiting multiple risk factors for cardiovascular disease. These individuals may present with intracardiac tumoral masses but their intrinsic cardiovascular risk —specifically concerning subclinical systemic inflammation and previous chemotherapeutical regimens 1,2—has not been investigated yet. To date, echocardiographic case-control studies in this population have never been performed and literature only offers reports on cardiac tissue invasion. Purpose The aim of this study was to compare echocardiographic parameters between patients with thymoma, predominantly in stage III to IV of the disease, and healthy controls, to determine whether significant differences in cardiac function exist. Methods Echocardiographic data were retrospectively collected from 60 patients, comprising 30 individuals diagnosed with thymus cancer and 30 matched controls. The latter were selected to match the patient group for age, sex, and common cardiovascular risk factors, including hypertension, type 2 diabetes mellitus, coronary artery disease, and dyslipidemia. After reviewing the exams, 23 patients with thymoma and 20 controls were included for final analysis based on the quality of the images. Clinical, electrocardiographic, and echocardiographic data were gathered and analyzed to assess significant differences using hypothesis testing (Table 1). Subsequently, regression analyses were performed to account for relevant variables. Results Statistical analysis revealed significant differences between thymoma patients and controls in various echocardiographic parameters, particularly in systolic function of both the left and right ventricles. Specifically, ejection fraction (EF) (p 0.001), global longitudinal strain (GLS) (p = 0.01), and tricuspid annular plane systolic excursion (TAPSE) (p = 0.001) were significantly reduced in patients with a previous diagnosis of thymoma. Linear regression analysis demonstrated that the strongest association was found with EF, which was significantly higher in the control group (B = 5.15, p 0.001, R = 0.5, R² = 0.27). Similarly, GLS was found to be higher in the control group (B = 1.7, p = 0.03, R = 0.3, R² = 0.12), as was TAPSE (B = 2.4, p = 0.01, R = 0.38, R² = 0.15). Also, the incidence of myasthenia gravis was not associated with any anomaly, although considering all patients were on antimyasthenics. Conclusions Our findings suggest that patients with thymoma exhibit significantly lower systolic function of both the left and right ventricles compared to controls. The reduction in systolic function could be attributed to several factors, including the effects of radiotherapy and chemotherapy, which a majority of these patients had undergone years prior to our assessment. Additionally, echocardiographic acoustic windows in thymoma patients were often suboptimal, likely as a consequence of prior mediastinal irradiation.Table depicting significant results.