Severe valvular heart disease affected 7.2% of cancer patients and increased mortality risk (adjHR 1.46), while interventions reduced mortality (adjHR 0.28).
Do valvular interventions improve survival in cancer patients with concurrent severe valvular heart disease?
Severe valvular heart disease is prevalent in cancer patients and associated with increased mortality, yet valvular interventions are rarely performed despite offering a significant survival benefit.
Absolute Event Rate: 0% vs 0%
Abstract Background The burden of cardio-oncologic disease is estimated to increase considerably due to remarkable advancements in cancer therapy over recent years. In this context, valvular heart disease (VHD), which is widespread in an aging population, may become a critical concern for future healthcare management. Despite its clinical relevance, the epidemiology, prognostic impact, and current management approaches of VHD in cancer patients remain poorly understood. Purpose The CESAR study aimed to evaluate the prevalence, characteristics, management approaches and associated outcomes of VHD in cancer patients. With this study, we strive to lay the foundation for prospective clinical trials aimed at optimizing management pathways of cancer patients with concurrent VHD. Methods This large-scale observational cohort study included adult patients (≥18 years) with confirmed oncologic diagnosis and a transthoracic echocardiographic at the time of cancer diagnosis (+/- 12 months) recruited at a tertiary referral center. Mortality (all-cause and cardiovascular), performance of valvular interventions, and their impact on survival served as endpoints. Multivariable Cox regression and adjusted Kaplan Meier estimates were used for outcome analyses. Performance of valve interventions was analyzed as a time-dependent variable. Results A total of 10,353 patients (46.6% female, 66.2±14.9 y/o), were included and 7.2% (n=749) had severe VHD. The distribution of severe valvular lesions was: aortic stenosis in 2.2% (n=224), mitral regurgitation in 2.6% (n=265), tricuspid regurgitation in 3.7% (n=381), and aortic regurgitation in 0.3% (n=35) of patients (Figure 1). Patients with severe VHD were older (mean 69 vs. 64y/o), with higher NT-proBNP levels (mean 6602 vs. 2156pg/mL), lower eGFR (mean 52 vs. 69ml/min/1.73m2), and higher prevalence of cardiovascular comorbidities (hypertension, diabetes, coronary artery disease) compared to those without significant VHD (all p0.001). Multivariable Cox regression (adjustment for age, sex, NT-proBNP, eGFR, left ventricular function) identified severe VHD as a predictor of increased mortality (adjHR 1.46, 95% CI 1.25–1.71) and cardiovascular death (adjHR 2.62, 95% CI 2.00-3.43). Among those with severe VHD, 161 (21.5%) received a valvular intervention during a median follow-up of 23.0 (IQR 6.5-70.3) months. Valvular interventions were independently associated with improved survival (adjHR 0.28, 95% CI 0.09-0.87, Figure 2). Conclusion Severe VHD is prevalent among cancer patients, accompanied by high-risk clinical and imaging features and independently associated with impaired survival. Valvular interventions are rarely performed despite conveyance of significant survival benefit. Low-risk transcatheter techniques represent VHD treatment modalities specifically tailored to the high-risk constellation of this population, which bare potential to ameliorate outcomes.Figure 1:Prevalence of VHD Figure 2:Valvular Intervention HR
Hauptmann et al. (Sat,) reported a other. Severe valvular heart disease affected 7.2% of cancer patients and increased mortality risk (adjHR 1.46), while interventions reduced mortality (adjHR 0.28).
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