Valvular heart disease in cancer patients - prevalence, relevance, and therapeutic management - preliminary results from the CESAR study

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. Current guidelines provide limited evidence-based recommendations for this population, highlighting the need for comprehensive investigation. Purpose The CESAR study aimed to evaluate the prevalence, characteristics, management approaches and associated outcomes of VHD in cancer patients. 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. Time of echocardiography served as baseline date for all 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. 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 p