Valvular Heart Disease following Anthracycline Therapy—Is It Time to Look beyond Ejection Fraction?

David Zahler, Joshua H. Arnold, Tali Bar-On, Ari Raphael, Shafik Khoury, Zach Rozenbaum, Shmuel Banai, Yaron Arbel, Yan Topilsky, Michal Laufer-Perl*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The association between anthracycline (ANT) and left ventricle (LV) dysfunction is well known; however, data regarding its direct effect on cardiac valve function is limited. We aimed to evaluate how ANT therapy affected valvular function in patients diagnosed with breast cancer. Data were prospectively collected as part of the Israel Cardio-Oncology Registry (ICOR). Patients underwent echocardiography exams at baseline (T1), during ANT therapy (T2), and after completion within 3 months (T3) and 6 months (T4). A total of 141 female patients were included, with a mean age of 51 ± 12 years. From T1 to T4, we observed a significant deterioration in LV ejection fraction (60.2 ± 1.5 to 59.2 ± 2.7%, p = 0.0004) and LV global longitudinal strain (−21.6 (−20.0–−23.0) to −20.0 (−19.1–−21.1)%, p < 0.0001)), and an increase in LV end-systolic diameter (25 (22–27) to 27 (24–30) mm, p < 0.0001). We observed a significant increase in the incidence of new mitral regurgitation (MR) development (4 to 19%, p < 0.0001), worsening with concomitant trastuzumab therapy (6% to 31%, p = 0.003), and a trend for tricuspid regurgitation development (4% to 8%, p = 0.19). ANT therapy is associated with the development of a new valvular disease, mainly MR, which may imply the need for a valvular focus in the monitoring of cancer patients.

Original languageEnglish
Article number1275
Issue number8
StatePublished - Aug 2022


FundersFunder number
Israel Cardio-Oncology Registry
Pfizer pharmaceuticals Israel Ltd.


    • cardio-oncology
    • cardiotoxicity
    • echocardiography
    • mitral regurgitation
    • tricuspid regurgitation
    • valve


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