Impact of Cancer Therapy-Related Cardiac Dysfunction on Risk of Heart Failure in Pregnancy

Mark Nolan, MBBS, PhD; Evangelos K. Oikonomou, MD; Candice K. Silversides, MD; Melissa R. Hines, MD; Kara A. Thompson, MD; Belinda A. Campbell, MBBS, MMed; Eitan Amir, MD, PhD; Cynthia Maxwell, MD; Paaladinesh Thavendiranathan, MD, SM

JACC. CardioOncology (Jun 2020)

Impact of Cancer Therapy-Related Cardiac Dysfunction on Risk of Heart Failure in Pregnancy

Mark Nolan, MBBS, PhD,
Evangelos K. Oikonomou, MD,
Candice K. Silversides, MD,
Melissa R. Hines, MD,
Kara A. Thompson, MD,
Belinda A. Campbell, MBBS, MMed,
Eitan Amir, MD, PhD,
Cynthia Maxwell, MD,
Paaladinesh Thavendiranathan, MD, SM

Affiliations

Mark Nolan, MBBS, PhD: Department of Medicine, Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
Evangelos K. Oikonomou, MD: Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
Candice K. Silversides, MD: Department of Medicine, Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Pregnancy and Heart Disease Program, Department of Medicine, Division of Cardiology, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada
Melissa R. Hines, MD: Division of Critical Care, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
Kara A. Thompson, MD: Department of Cardiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
Belinda A. Campbell, MBBS, MMed: Department of Radiation Oncology, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia, and Department of Clinical Pathology, The University of Melbourne, Parkville, Victoria, Australia
Eitan Amir, MD, PhD: Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Cynthia Maxwell, MD: Department of Obstetrics and Gynecology, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
Paaladinesh Thavendiranathan, MD, SM: Department of Medicine, Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Joint Division of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada; Address for correspondence: Dr. Paaladinesh Thavendiranathan, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.

Journal volume & issue: Vol. 2, no. 2
pp. 153 – 162

Abstract

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Background: Cancer treatment can lead to left ventricular (LV) dysfunction in female cancer survivors of reproductive age, and pregnancy-related hemodynamic stress may result in LV dysfunction or heart failure (HF). Objectives: We performed a systematic review and meta-analysis to determine the incidence of LV systolic dysfunction or HF during or soon after pregnancy in cancer survivors and evaluated the impact of history of cancer therapeutics-related cardiac dysfunction (CTRCD). Methods: We systematically searched electronic databases (MEDLINE and EMBASE) from inception to January 2020 to identify cohort studies that examined cardiac disease in pregnant cancer survivors. Meta-analysis was performed using the inverse-variance fixed effects method. Potential sources of heterogeneity were explored using subgroup analyses and meta-regression. Results: Of 13,782 identified articles, 6 studies consisting of 2,016 pregnancies, predominantly in childhood cancer survivors, were included. Overall, there were 33 cardiac events. The total weighted incidence of LV dysfunction or HF with pregnancy was 1.7% (95% confidence interval [CI]: 0.9% to 2.7%) overall; 28.4% (95% CI: 14.6% to 43.9%) in those with a history of CTRCD and 0.24% (95% CI: 0% to 0.81%) in those without, translating into an odds ratio of 47.4 (95% CI: 17.9 to 125.8). Interstudy heterogeneity was low (I2 = 17.5%). Metaregression did not reveal significant sources of heterogeneity. Conclusions: The incidence of LV dysfunction or HF during pregnancy in cancer survivors was low. Although risk estimates are limited by the small number of events, women with a history of CTRCD compared to those without had a 47.4-fold higher odds of experiencing pregnancy-related LV dysfunction or HF.

Published in JACC. CardioOncology

ISSN: 2666-0873 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jacc-cardiooncology

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