###### Abstract  
Background: The aim of this study was to assess the role of cardiac and vascular parameters as all-cause mortality determinants in patients suffering from gynecological cancers. Methods: This was an observational, prospective, non-randomized, and non-controlled study. Forty-seven consecutive patients (mean age: 58 \(\pm\) 13 years) were enrolled after cancer staging. All patients underwent evaluation of vascular (common carotid intima-media thickness (mean C-IMT), flow-mediated dilation of the brachial artery (FMD), and antero-posterior diameter of the intracranial abdominal aorta (APAO)) and cardiac function and morphology before cancer-related interventions. A 6-year follow-up was carried out to assess the overall survival of the whole population. Results: Twenty patients (4%) died by the time of the 6-year follow-up. The brachial artery FMD values were higher in the survivors than the non-survivors (9.71 \(\pm\) 3.53% vs. 6.13 \(\pm\) 2.62%, \(p\)\(<\) 0.001), as well as the LVEF (60.8 \(\pm\) 3.0% vs. 57.8 \(\pm\) 4.4%, \(p\) = 0.009). There were no differences in the mean C-IMT, APAO, and other echocardiographic parameters. ROC curve analysis identified a baseline LVEF \(<\) 57% and FMD value \(<\) 5.8% as the best cut-offs. Kaplan-Meier evaluation showed that the LVEF, tricuspid annular plane systolic excursion, and FMD were the best predictors of all-cause mortality, although only the LVEF and FMD were confirmed in multivariate Cox regression analysis. Conclusions: The LVEF and brachial artery FMD are independent prognostic determinants in patients with gynecological cancers.  
Keywords: gynecological cancer; cardiovascular risk profile; all-cause mortality; baseline evaluation; FMD; LVEF +
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survival of patients suffering from gynecological cancers [5; 6; 7]. Nevertheless, anti-tumor drugs may be associated with significant cardiovascular toxicity. About 30% of patients treated with chemotherapy develop abnormal heart functioning, which is classified as \"relevant\" in 15% and \"serious\" (risk of fatal heart failure) in 1% of cases [8]. Cardio-vascular toxicity worsens the prognoses of these patients and limits the choice of the chemotherapeutic regimen, the dose intensity, and the potential anti-tumor efficacy of the therapy.  
Parallel to that, there is growing evidence for possible crosstalk between the heart and cancer, which can deeply impact the prognoses of patients independent from the natural history of the neoplasm [9; 10]. It has been recognized that heart failure can promote tumor growth by itself by means of the excretion of specific cardiac factors [11]. Such a relationship seems to be independent from the alterations in hemodynamics related to heart dysfunction [11].  
The reciprocal linkage between the heart and cancer and the possible impact on patients' survival force evaluators to perform a comprehensive evaluation of patients suffering with neoplasms in order to detect early signs that might increase their risk for adverse events [9].  
The literature offers scant data about the identification of specific cardiac determinants able to predict the prognoses of patients with cancers independent from the specific antiblastic treatment [12].  
The aim of this study was to assess the impact of baseline cardiac and vascular parameters on the prognoses of women suffering with major gynecological cancers (uterine corpus, cervical, and ovarian).