Prognosis of Cancer Patients with Aortic Stenosis Under Optimal Cancer Therapies and Conservative Cardiac Treatments

Abstract

Aortic stenosis (AS) is a life-threatening comorbidity of cancer patients. Aortic valve replacement (AVR) should be considered for some cancer patients, but neither the characteristics nor prognosis under conservative therapy is well known.We searched our echocardiography log (years 2005-2014) for cancer patients with AS, and 92 patients (54% female) were included in the study. To compare the survival curves, 470 control patients without AS were selected from our cancer registry.Mean age (± SD) was 77.6 ± 6.7 years for males and 81.6 ± 6.3 years for females. Mean aortic valve area (AVA) was 1.0 ± 0.3 cm. Stomach, blood, and urinary bladder cancers were the major sites of current cancer. During the 5-year follow-up period, 44 patients with AS (48%) died; 26 (59%) due to cancer progression, 10 (23%) heart failure, and 4 (9%) stroke. Heart-failure death was significantly higher for patients with AS than for control patients (P < 0.001). Kaplan-Meier survival estimates were worse for stage I or II patients with AVA < 0.75 cm than for control patients (P = 0.016). Older age, advanced stages, absence of dyslipidemia, recent syncope, and chronic heart failure or AVA < 0.75 cm were significantly and independently associated with poor survival.Although the majority of cancer patients with AS died of cancer, a quarter died of heart failure. Careful follow-up is needed because cancer patients at earlier stages with symptomatic AS or AVA < 0.75 cm should be considered for AVR.

Future projection of cancer patients with cardiovascular disease in Japan by the year 2039: a pilot study

“…Our hospital maintains a cancer registry that is regularly updated with the clinical information and vital statuses of patients. The dates of initial diagnosis, clinical and pathological diagnosis, and death were obtained from the registry [6, 9].…”

“…Systemic screening at our hospital is performed before cancer therapy, as previously described [6, 9]. All patients underwent a physical examination, 95% submitted to electrocardiograms, and 53% underwent chest radiographies.…”

“…CVD is endemic among cancer patients; hypertension, atrial fibrillation (AF), ischemic heart disease (IHD), venous thromboembolism (VTE), LVD, and heart failure (HF) are common comorbidities [5, 6]. This is attributable to common risk factors shared by cancer and CVD (e.g., aging, smoking, diabetes, obesity, and physical inactivity), neoplastic effects on the cardiovascular system, chemotherapy- and radiotherapy-induced cardiovascular toxicities, and longer life expectancies [1, 3, 6–9].…”

The Onco-cardiologist Dilemma: to Implant, to Defer, or to Avoid Transcatheter Aortic Valve Replacement in Cancer Patients with Aortic Stenosis?

“…There are very few reports regarding the prognosis of patients with valvular disease and cancer, and even less are available in patients with AS. In a 10year single-center retrospective study, cancer patients with severe AS and a mean aortic valve area 1.0 ± 0.3 cm 2 had a 5-year mortality of 48% [29]. Most deaths (59%) were due to cancer progression, but 31% were due to heart failure and stroke.…”

“…Patients with severe AS are poor candidates for surgery mainly because of comorbidities that increase the estimated periprocedural morbidity and mortality. However, patients with cancer in early stages with symptomatic AS or an aortic valve area under 0.75 cm 2 should be considered for AVR [29]. Occasional reports describe SAVR being performed prior to cancer surgery, yielding various results [43].…”