Valvular heart disease, detected through cardiovascular imaging, is common in cancer patients. Interventions to treat valvular heart disease significantly improved survival. These findings were presented today at EACVI 2025, the flagship conference of the European Association of Cardiovascular Imaging (EACVI), a branch of the European Society of Cardiology (ESC).
Advances in treatment have led to improved survival for cancer patients. As patients live longer, they are at increased risk of developing valvular disease after successful cancer treatment. In addition, it is now widely recognized that some cancer treatments can cause cardiovascular toxicity that can lead to premature morbidity among cancer survivors.
“Cardiovascular complications are becoming increasingly important in elderly patients after successful cancer treatment. For example, we already know that anthracycline chemotherapy causes heart failure and can lead to tricuspid and mitral regurgitation.explained study presenter Dr. Maximilian Autherith from the Medical University of Vienna, Austria, who continued:There is limited evidence to guide the most appropriate management plan for cancer patients with concomitant valvular heart disease, for example, whether patients benefit from valvular interventions to a similar extent as patients without cancerThe CESAR study sought to determine the prevalence of valvular heart disease in cancer patients, describe the frequency of valvular interventions, and assess the impact of interventions on survival.
The observational cohort study included 10,353 adult patients with a confirmed diagnosis of cancer who had undergone transthoracic echocardiography within 12 months at a tertiary referral center. The mean age of the population was 66.2 years and about half (46.6%) were women.
The researchers found that 7.2% of patients had severe valvular heart disease, most commonly tricuspid (3.7%), mitral regurgitation (2.6%) and aortic stenosis (2.2%). After adjustment for age, sex, cardiac biomarker levels, renal function, and left ventricular function, severe valvular heart disease was found to be an independent predictor of increased mortality (adjusted hazard ratio [HR] 1.46? 95% confidence interval [CI] 1.25-1.71) and cardiovascular death (adjusted HR 2.62, 95% CI 2.00-3.43).
Among those with severe valvular disease, 21.5% underwent surgery or transcatheter intervention. Specifically, a valve intervention was independently associated with improved survival compared with no valve intervention, resulting in a 72% reduction in mortality (adjusted HR 0.28, 95% CI 0.09–0.87) after a median follow-up of 23 months.
Summarizing the findings, Dr Autherith said:Severe valvular heart disease was prevalent in this selected population of cancer patients undergoing echocardiography. Only a small proportion of patients underwent interventions to treat valvular heart disease, but when they did, the impact on survival was significant. Our findings highlight the need to refer cancer patients for routine cardiovascular monitoring and also suggest that interventions for valvular heart disease need not be withheld in this population. Next steps include further analysis of different cancer treatments being administered and interventions being performed.”
