Heart Failure Uncommon in Pregnant Cancer Survivors
NEW YORK (Reuters Health) - Female cancer survivors exposed to potentially cardiotoxic treatments rarely develop new congestive heart failure (CHF) during pregnancy, researchers from Canada report.
"The low incidence of cardiac complications in women without a prior history of cardiotoxicity was a very interesting finding as it provides information to counsel our patients," Dr. Paaladinesh Thavendiranathan from University Health Network and Mount Sinai Hospital and the University of Toronto told Reuters Health by email.
Dr. Thavendiranathan and colleagues evaluated adverse maternal cardiac events during 94 pregnancies in 78 women previously exposed to potentially cardiotoxic treatments. Most (55/78) had received anthracyclines, 23 had received nonanthracycline chemotherapy and/or radiation therapy only, and 15 (16%) of the 94 pregnancies occurred in 13 women with a prior history of cardiotoxicity.
Among the women with prior cardiotoxicity, five had normal left ventricular ejection fraction (LVEF), five had mildly reduced LVEF, two had moderately reduced LVEF, and one had LVEF of 25% at the first antenatal visit. All but one of these women were in New York Heart Association functional class I.
Five pregnancies were complicated by CHF, all of them in women with a history of cardiotoxicity, the researchers reported October 23rd online in the Journal of the American College of Cardiology.
The incidence of CHF was 31% (4/13) in women with a history of cardiotoxicity and 0% (0/65) in women without a history of cardiotoxicity.
Women with CHF during pregnancy were more likely to have had a history of cardiotoxicity before pregnancy, left ventricular systolic dysfunction at the first antenatal visit, and to be on cardiac medications.
There were no maternal or neonatal deaths, and obstetric and perinatal outcomes were similar to those previously reported in cancer survivors.
"Patients with prior history of cardiotoxicity or those who have subclinical cardiac dysfunction should be followed in a cardiology clinic with special expertise in managing these patients," Dr. Thavendiranathan said. "This would help guide frequency of cardiac follow-up and co-management of patient with the obstetricians throughout the pregnancy. Furthermore, this collaboration will be critical at the time of delivery and in the early postpartum period."
"Such careful assessment and follow-up may help reduce the risk of decompensated heart failure during pregnancy," he said. "Whether certain safe medications during pregnancy can prevent decompensation also would need to be studied."
Dr. Richard A. Anderson from University of Edinburgh, UK, who has researched reproductive outcomes and perinatal risks in female cancer survivors, told Reuters Health by email, "The key finding to me is the low risk in women without previous cardiotoxicity. This emphasizes the need for assessment of all women who have received potentially cardiotoxic treatment after treatment, or before conception, and that women should be aware of their status."
"Many women, and most girls, treated for cancer can expect to have normal pregnancies thereafter," he said. "However, there is a critical need to identify those whose treatment will have impacted on either their fertility or their ability to carry a pregnancy successfully and to provide detailed assessment and individualized advice."
J Am Coll Cardiol 2018.