Severe valvular heart disease (VHD) is common in patients with cancer and is linked to poorer survival. Procedures on the heart valves — especially catheter-based interventions — may improve prognosis but appear underused in this population, according to new data from the CESAR study, the European Society of Cardiology (ESC) said. The data were presented recently at the congress of the European Association of Cardiovascular Imaging, the ESC’s cardiovascular imaging branch, in Vienna, Austria.

Rising Life Expectancy and Cardiotoxic Therapies

Cancer and cardiovascular disease are the leading causes of death in the Western world, according to an article in Herz, a German cardiology journal. In 2021 in Germany, 340,619 people died of cardiovascular disease, followed by 229,068 who died of cancer, according to an analysis by the Federal Statistical Office, Germany’s national statistics agency. The two disease groups are interrelated. Cardiac complications occur more often in patients with cancer because advances in oncology diagnostics and therapy have improved survival, and some tumor therapies are cardiotoxic.

In addition, possible links between existing cardiovascular disease and later malignancy suggest that patients with cardiovascular disease have a higher cancer risk than the general population, reported Lars Michel and Tienush Rassaf, both from the Department of Cardiology and Angiology at University Hospital Essen, Essen, Germany. Cardiovascular disease and cancer likely share risk factors, which may partly explain their co-occurrence, Michel and Rassaf noted. Reflecting the growing importance of cardiac disease in oncology, the ESC, in collaboration with other societies, published its first cardio-oncology guideline 3 years ago.

VHD in Cancer Understudied

Cardiac complications in patients with cancer include toxic cardiomyopathies, thromboembolism, arrhythmias, and vascular injury; after successful cancer therapy, they also face an increased risk of developing VHD. Despite its clinical relevance, the epidemiology, prognostic impact, and current treatment approaches for VHD in patients with cancer remain poorly defined, the ESC said. Current guidelines offer only limited evidence-based recommendations for this population, underscoring the need for comprehensive study.

“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,” said Maximilian Autherith of the Medical University of Vienna, Vienna, Austria, who presented the CESAR data. The study was initiated because “there is limited evidence to guide the most appropriate management plan for cancer patients with concomitant VHD, for instance, whether patients benefit from valvular interventions to a similar extent as patients without cancer.”

The observational study included 10,353 adults with a confirmed cancer diagnosis who underwent transthoracic echocardiography within 12 months at a tertiary referral center.

CESAR Study Results

Of the 10,353 patients (46.6% female; mean age, 66.2 years), 749 (7.2%) had severe VHD. Distribution of severe valve lesions:

• Aortic stenosis: 2.2% (n = 224)
• Mitral regurgitation: 2.6% (n = 265)
• Tricuspid regurgitation: 3.7% (n = 381)
• Aortic regurgitation: 0.3% (n = 35)

Patients with severe VHD were older (mean, 69 vs 64 years), had higher N-terminal pro-B-type natriuretic peptide levels (mean, 6602 vs 2156 pg/mL), lower estimated glomerular filtration rate (mean, 52 vs 69 mL/min/1.73 m²), and a higher prevalence of cardiovascular comorbidities, including hypertension, diabetes, and coronary artery disease, than patients without significant VHD.

Statistical analyses showed that severe VHD — after adjustment for age, sex, cardiac biomarker levels, renal function, and left ventricular function — was associated with an increased risk for all-cause mortality (adjusted hazard ratio [HR], 1.46) and cardiovascular death (adjusted HR, 2.62).

In 21.5% of patients with severe VHD (n = 161), a valve procedure (catheter-based or conventional surgery) was performed during a median follow-up of 23 months. Valve interventions were associated with improved survival (72% reduction in mortality; adjusted HR, 0.28).

“Severe VHD was prevalent in this selected population of cancer patients who underwent echocardiography. Only a small proportion of patients underwent interventions to treat VHD, 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 VHD do not need to be withheld in this population. The next steps include further analysis of different administered cancer treatments and performed interventions,” noted Autherith.

This story was translated from Univadis Germany, part of the Medscape Professional network.