Hamartoma of mature cardiac myocytes: systematic review
Witina Techasatian1, Maan Gozun1, Clarke Morihara1
1Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA.
Insights
Cardiac hamartomas are underrecognized primary heart tumors that can cause sudden death. Early diagnosis and treatment are crucial for managing these rare conditions.
Area of Science:
- Cardiology
- Oncology
- Pathology
Background:
- Primary cardiac tumors are rare but increasingly detected.
- Hamartoma of mature cardiac myocytes is an underrecognized cardiac tumor.
- This condition can lead to critical outcomes, including sudden death.
Approach:
- Systematic review adhering to PRISMA guidelines.
- Searched MEDLINE and EMBASE for relevant literature up to January 2, 2023.
- Included 25 articles detailing 34 cases of cardiac myocyte hamartoma.
Key Points:
- Dyspnea was the most common symptom (35.3%), with some cases presenting as sudden death or syncope.
- The left ventricle was the most frequent site (41.2%), followed by the right atrium and ventricle.
- Diagnosis and treatment often involved surgery; some cases required cardiac transplant or were fatal.
Conclusions:
- Cardiac myocyte hamartoma is a potentially underrecognized tumor with serious consequences.
- Differentiating from malignancy like angiosarcoma requires multimodal imaging.
- Further research is needed for noninvasive diagnostic methods.
Background:
While primary cardiac tumors are rare, it has been increasingly recognized due to improvement in screening measures. However, the hamartoma of mature cardiac myocytes has been underrecognized compared to other cardiac tumors, such as cardiac myxomas and papillary fibroelastomas, and is still potentially associated with critical consequences such as sudden death. This systematic review aims to summarize the evidence regarding the hamartoma of mature cardiac myocytes and characterize the presentations and symptoms for clinicians.
Methods:
Following the PRISMA statement, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including "hamartoma of mature cardiac myocytes" from their inception to January 2, 2023.
Results:
We included 25 articles, including 34 cases, in this systematic review. Patients with hamartoma of mature cardiac myocytes commonly presented with nonspecific symptoms such as dyspnea (35.3%), although a few presented with sudden death and syncope. The left ventricle was the common site of origin (41.2%), followed by the right atrium and ventricle. Surgery was commonly pursued for diagnosis and treatment, while a few required cardiac transplants (8.8%), and 29.4% were diagnosed with autopsy or expired.
Conclusion:
Hamartoma of mature cardiac myocytes is a potentially underrecognized primary cardiac tumor associated with treatable yet potentially critical consequences. Given the challenges of differentiating it from malignancy such as angiosarcoma, multimodal imaging needs to be utilized to pursue a diagnosis. Future studies are warranted to develop a noninvasive diagnosis mode for cardiac tumor.
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