Valvular heart disease, identified through cardiovascular imaging, is common in cancer patients. Interventions to treat valvular heart disease significantly improved survival.1 These findings were presented today at EACVI 2025, the flagship congress of the European Association of Cardiovascular Imaging (EACVI), a branch of the European Society of Cardiology (ESC).
Treatment advances have led to improved survival for patients with cancer. As patients live longer, they are at an increased risk of developing valvular heart disease after successful cancer therapy. Furthermore, it is now well recognised that certain cancer treatments can cause cardiovascular toxicity that may lead to premature morbidity among cancer survivors.2
"Cardiovascular complications are becoming increasingly relevant in older patients after successful cancer therapy. For example, we already know that anthracycline chemotherapy causes heart failure and might lead to tricuspid and mitral valve regurgitation," explained study presenter, Doctor 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 instance, whether patients benefit from valvular interventions to a similar extent as patients without cancer." The CESAR study sought to determine the prevalence of valvular heart disease in patients with cancer, describe the frequency of valve interventions and evaluate the impact of interventions on survival.
The observational cohort study included 10,353 adult patients with a confirmed cancer diagnosis who had undergone transthoracic echocardiography within 12 months at a tertiary referral centre. The mean age of the population was 66.2 years and around half (46.6%) were female.
The researchers found that 7.2% of patients had severe valvular heart disease, most commonly tricuspid regurgitation (3.7%), mitral regurgitation (2.6%) and aortic stenosis (2.2%). After adjustment for age, sex, levels of cardiac biomarkers, kidney 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 heart disease, 21.5% underwent a surgical or transcatheter intervention. Notably, a valvular intervention was independently associated with improved survival compared to no valvular intervention, resulting in a 72% mortality reduction (adjusted HR 0.28; 95% CI 0.09–0.87) after a median follow-up of 23 months.
Summing up the findings, Doctor Autherith said: "Severe valvular heart disease was prevalent in this selected population of cancer patients who underwent echocardiography. Only a small proportion of patients underwent interventions to treat valvular heart disease, but when they did, the impact on survival was considerable. Our findings highlight the need to refer cancer patients for regular cardiovascular monitoring and also suggest that interventions for valvular heart disease do not need to be withheld in this population. The next steps include further analysis of different administered cancer treatments and performed interventions."
