Aortic stenosis is the most common valvular complication of mediastinal radiotherapy. In 2016 was shown that not only radiotherapy but chemotherapy with anthracyclines alone may provoke the development of valvular heart diseases (VHD). But there are still not clear time frames of VHD development.
We present a single-center retrospective analysis of a cohort with breast cancer history who were treated in cardiology departments. Total 91 patients were included in this study. ECHO data and time till first symptoms and surgical treatment were assessed in all patients.
Different VHD were revealed in 48.35% (n=44) of patients. Among them 54.5% (n=24) had aortic stenosis, 34.1% (n=15) – mitral regurgitation, 4.5% (n=2) – mitral stenosis with regurgitation, 2.3% (n=1) – isolated aortic regurgitation and the same number of isolated mitral stenosis. During 15 months 25 patients were undergoing surgical treatment. In 2 of them VHD was first diagnosed before cancer treatment, so they weren’t included in the subsequent analysis. The oncological age in operated patients was 60 [42; 68] years. The time till first signs of VHD was 8 [4; 16.5] years. In all patients dyspnea was presented, 39% of patients had angina and only in 21.7% had presyncopes and syncopes. The median time from oncological age till surgery was 11 [7; 22] years. We also revealed correlation between oncological age and time till first VHD signs and surgical treatment (r = -0.76 and r = -0.71 respectively).
Given the widespread prevalence of degenerative aortic stenosis in older age patients, it is advisable to assess valves condition not only before radiation and chemotherapy but also recommend more frequent echocardiographic monitoring after, as well as use of new visualization techniques, such as CT (calcium score) and 18F-NaF PET-CT (as marker of calcification).
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All authors have declared no conflicts of interest.