Correlation of cardiac valvular vegetations with thromboembolism and plasma d-dimer levels - a prospective echocardiographic study of 200 cancer patients

Non-bacterial thrombotic endocarditis (NBTE) can complicate various malignancies and may cause morbidity and mortality mainly as a result of systemic embolism The antemortem diagnosis of NBTE is rare. The purpose of our study was to assess in cancer patients the frequency, echocardiographic characteristics and correlations of NBTE with D-dimer plasma levels and thromboembolism (TE). Methods: A prospective echocardiographic screening of 200 non-selected ambulatory patients with solid tumors was performed Patients were evaluated for evidence of (TE) Plasma D-dimer levels were analyzed by latex and SimpliRed assays (Agen, Australia). Results: The study group included 90 women and 110 men, median age 64 years (range 21-91). The frequent malignancies were lymphoma (25%), carcinoma of the gastrointestinal tract (22%), carcinoma of the lung (16%) and gynecological and urinary tract (16%). Cardiac valvular vegetations were found in 37 patients (18.5%) Valvular lesions were most common in patients with tumors of pancreas (4/7, 57%), lung 11/32, 34%) and in lymphoma patients (12/49, 24%). TE was diagnosed in 25 (125%) patients (15 deep vein thrombosis, 5 emboli to extremities, 2 cerebrovascular accidents and 3 patients with acute myocardial infarction) TE was found in 10 of 37 patients (27%) with vegetations compared to 15 of 163 patients without vegetations (9%), p=0.026 D-dimer levels were increased in 99/172 patients (57.5%), including (18/25) patients (72%) with valvular lesions and evidence of TE. Conclusions: This study demonstrates a high prevalence of cardiac valvular lesions in patients with lymphoma and solid tumors. Vegetations are associated with TE and increased plasma D-dimer levels.