In the Journals

History of cardiotoxicity, cancer treatment linked to congestive HF during, after pregnancy

Women with a prior history of cardiotoxicity previously treated for cancer with radiation or chemotherapy had elevated odds of developing clinical congestive HF during and after pregnancy, according to a study published in the Journal of the American College of Cardiology.

“For women without a history of cardiotoxicity, their risk of developing [congestive] HF during pregnancy is very low,” Paaladinesh Thavendiranathan, MD, SM, director of the Ted Rogers Program in Cardiotoxicity Prevention at Toronto General Hospital, said in a press release. “However, for women who have been exposed to cardiotoxic treatments and have had prior cardiotoxicity, there’s approximately a 1 in 3 chance of developing [congestive] HF with pregnancy. These women should receive close cardiac surveillance during pregnancy.”

Shiying Liu, MD, internal medicine resident at the University of Toronto, and colleagues analyzed data from 78 women with 94 pregnancies who were treated for cancer with chemotherapy and/or radiation and were seen at high-risk pregnancy clinics between 2005 and 2015. Of the women included in the study, 55 received anthracyclines and 23 received nonanthracycline chemotherapy and/or radiation only.

A history of cardiotoxicity was defined as a reduction in left ventricular ejection fraction to less than 50% after cancer therapy was completed, regardless of the presence of congestive HF symptoms.

The primary outcome was a composite of adverse maternal cardiac events, including clinical congestive HF, cardiac death, sustained arrythmia and ACS. Women were assessed during pregnancy and up to 16 weeks postpartum.

Women with a history of cardiotoxicity (n = 13) accounted for 16% of pregnancies in the cohort.

The primary outcome occurred in 5.3% of pregnancies in four women, which was predominantly congestive HF. Congestive HF was observed more often in women with a history of cardiotoxicity (31%; 95% CI, 13-58) compared with those without a history of cardiotoxicity (0%; 95% CI, 0-6; P < .001).

Between women with (n = 4) and without (n = 74) congestive HF during pregnancy, there were no significant differences in the age at pregnancy (35 years vs. 34 years, respectively; P = .79), age at cancer diagnosis (28 years vs. 25 years, respectively; P = .68), exposure to anthracyclines (75% vs. 70%, respectively; P = .84) and cancer type.

Compared with women without congestive HF during pregnancy, those who had the condition were more likely to have LV systolic dysfunction at the first antenatal visit (75% vs. 8%; P = .004), to have a history of cardiotoxicity before pregnancy (100% vs. 12%; P = .007) or to be on cardiac medications (50% vs. 8%; P = .026).

“We found that the risk of developing [congestive] HF during pregnancy is rare in female cancer survivors without a history of cardiotoxicity,” Liu and colleagues wrote. – by Darlene Dobkowski

Disclosures: Liu reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Women with a prior history of cardiotoxicity previously treated for cancer with radiation or chemotherapy had elevated odds of developing clinical congestive HF during and after pregnancy, according to a study published in the Journal of the American College of Cardiology.

“For women without a history of cardiotoxicity, their risk of developing [congestive] HF during pregnancy is very low,” Paaladinesh Thavendiranathan, MD, SM, director of the Ted Rogers Program in Cardiotoxicity Prevention at Toronto General Hospital, said in a press release. “However, for women who have been exposed to cardiotoxic treatments and have had prior cardiotoxicity, there’s approximately a 1 in 3 chance of developing [congestive] HF with pregnancy. These women should receive close cardiac surveillance during pregnancy.”

Shiying Liu, MD, internal medicine resident at the University of Toronto, and colleagues analyzed data from 78 women with 94 pregnancies who were treated for cancer with chemotherapy and/or radiation and were seen at high-risk pregnancy clinics between 2005 and 2015. Of the women included in the study, 55 received anthracyclines and 23 received nonanthracycline chemotherapy and/or radiation only.

A history of cardiotoxicity was defined as a reduction in left ventricular ejection fraction to less than 50% after cancer therapy was completed, regardless of the presence of congestive HF symptoms.

The primary outcome was a composite of adverse maternal cardiac events, including clinical congestive HF, cardiac death, sustained arrythmia and ACS. Women were assessed during pregnancy and up to 16 weeks postpartum.

Women with a history of cardiotoxicity (n = 13) accounted for 16% of pregnancies in the cohort.

The primary outcome occurred in 5.3% of pregnancies in four women, which was predominantly congestive HF. Congestive HF was observed more often in women with a history of cardiotoxicity (31%; 95% CI, 13-58) compared with those without a history of cardiotoxicity (0%; 95% CI, 0-6; P < .001).

Between women with (n = 4) and without (n = 74) congestive HF during pregnancy, there were no significant differences in the age at pregnancy (35 years vs. 34 years, respectively; P = .79), age at cancer diagnosis (28 years vs. 25 years, respectively; P = .68), exposure to anthracyclines (75% vs. 70%, respectively; P = .84) and cancer type.

Compared with women without congestive HF during pregnancy, those who had the condition were more likely to have LV systolic dysfunction at the first antenatal visit (75% vs. 8%; P = .004), to have a history of cardiotoxicity before pregnancy (100% vs. 12%; P = .007) or to be on cardiac medications (50% vs. 8%; P = .026).

“We found that the risk of developing [congestive] HF during pregnancy is rare in female cancer survivors without a history of cardiotoxicity,” Liu and colleagues wrote. – by Darlene Dobkowski

Disclosures: Liu reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.