Valvular heart disease in patients with cancer: Pathophysiology, epidemiology, and multimodality cardio-oncology management with proportional Heart Team decisions. A narrative review
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Copyright (c) 2026 Paola Chong Velásquez
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
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https://doi.org/10.33821/844Keywords:
cardio-oncology, heart valve diseases, neoplasms, diagnostic imaging, risk stratification, clinical decision-makingAbstract
Introduction: The increasing survival of patients with cancer has led to a higher prevalence of concomitant cardiovascular disease. Valvular heart disease is common and frequently underdiagnosed in oncologic patients, particularly following mediastinal radiotherapy or in the setting of therapy-related cardiotoxicity, with significant prognostic implications and potential interference with the continuity of oncologic treatment. Objective: To propose a structured clinical framework for the evaluation and management of valvular heart disease in patients with cancer, integrating pathophysiology, multimodality imaging, and proportional decision-making through a cardio-oncology Heart Team. Materials and methods: A narrative literature review was conducted using a PubMed/MEDLINE search between January 2000 and December 2025. MeSH terms and keywords related to valvular heart disease, neoplasms, cardio-oncology, radiotherapy, transcatheter valve interventions, and multimodality imaging were used. Articles were selected through title, abstract, and full-text review, complemented by a manual search of relevant references. Results: Clinical decision-making can be structured across four domains: evaluation of valvular severity and mechanism using multimodality imaging; estimation of net clinical benefit considering the oncologic trajectory; assessment of frailty, functional status, and patient preferences; and selection of proportional therapeutic strategies, prioritizing minimally invasive approaches when anatomy and prognosis allow. Conclusions: The management of valvular heart disease in patients with cancer requires a standardized approach based on multimodality imaging, comprehensive risk stratification, and Heart Team deliberation, avoiding undertreatment based solely on a history of cancer and prioritizing patient-centered clinical benefit.
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