Abstract
Long-term survivors of childhood, adolescent and young adult (AYA) malignancies with past exposure to potentially cardiotoxic treatments are at risk of peripartum cardiac dysfunction. Incidence and risk factors for peripartum cardiac dysfunction and maternal cardiac outcomes in this population were investigated. Eligible long-term survivors were aged <30 years at cancer diagnosis, with ≥1 pregnancy occurring ≥5 years after diagnosis. “Peripartum” cardiac events were defined as occurring within pregnancy or ≤5months after delivery. Cardiac events were classified “symptomatic” or “subclinical”. “Peripartum cardiomyopathy” (PPCM) was defined as symptomatic dysfunction without prior cardiac dysfunction. Of 64 eligible women, 5 (7.8%) had peripartum cardiac events: 3 symptomatic, 2 subclinical. Of 110 live births, 2 (1.8%, 95% CI 0.2–6.4) were defined as PPCM: Significantly greater than the published general population incidence of 1:3000 (p < 0.001), representing a 55-fold (95% CI 6.6–192.0) increased risk. Risk factor analyses were hypothesis-generating, revealing younger age at cancer diagnosis and higher anthracycline dose. Postpartum, cardiac function of 4 women (80%) failed to return to baseline. In conclusion, peripartum cardiac dysfunction is an uncommon but potentially serious complication in long-term survivors of paediatric and AYA malignancies previously treated with cardiotoxic therapies. Peripartum cardiac assessment is strongly recommended for at-risk patients.
Highlights
Long-term survivors of malignancy are at risk of late complications from exposure to past cytotoxic therapies [1]
We investigate the risk of peripartum cardiac dysfunction in long-term survivors of malignancy
Peripartum cardiac dysfunction is uncommon in long-term survivors of malignancy with prior exposure to cardiotoxic therapies
Summary
Long-term survivors of malignancy are at risk of late complications from exposure to past cytotoxic therapies [1]. Anthracycline-containing chemotherapy and chest radiotherapy are known to be associated with long-term, dose-dependent cardiotoxicity, which can manifest as clinical or subclinical cardiac dysfunction [2,3]. Long-term survivors of paediatric, adolescent and young adult (AYA) malignancies represent a vulnerable group due to their younger age at past exposure, likelihood of poor patient recollection of past treatments and potential patient phobias stemming from these early medical interactions at a younger age [8]. For the recipients of past cardiotoxic therapies, peripartum cardiac dysfunction is a concern [9,10], in particular, the ability to accommodate the associated physiological cardiovascular demands of pregnancy and childbirth, including increased maternal blood volume, preload, heart rate and cardiac output [11,12]
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