Peripartum Cardiomyopathy Occurring in a Patient Previously Treated With Doxorubicin

Katz, Arie; Goldenberg, Ilan; Maoz, C; Thaler, Michael; Grossman, Ehud; Rosenthal, Talma

doi:10.1016/s0002-9629(15)40251-4

Cited by 10 publications

(3 citation statements)

References 12 publications

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“…Women who experienced chemotherapy‐induced cardiotoxicity have a higher risk for developing HF during pregnancy 8 . Moreover, previous cardiotoxic cancer therapies may trigger PPCM, even in the absence of left ventricular (LV) dysfunction immediately after cancer therapies 9,10 . In the same collective of PPCM patients with cancer, gene variants associated with an increased risk for cancer predisposition syndrome, especially in the DNA damage response pathway (DDR), were observed suggesting potential connections to pregnancy‐associated cardiomyopathy as a form of late cardiotoxicity due to anticancer treatment 6 .…”

Section: Pathophysiology Of Heart Failure In Genetic Idiopathic and Cardiotoxic Therapy‐related Cardiomyopathies And Its Impact On The Pementioning

confidence: 99%

Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

Sliwa

Meer

Petrie

et al. 2021

European J of Heart Fail

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This position paper focusses on the pathophysiology, diagnosis and management of women diagnosed with a cardiomyopathy, or at risk of heart failure (HF), who are planning to conceive or present with (de novo or previously unknown) HF during or after pregnancy. This includes the heterogeneous group of heart muscle diseases such as hypertrophic, dilated, arrhythmogenic right ventricular and non‐classified cardiomyopathies, left ventricular non‐compaction, peripartum cardiomyopathy, Takotsubo syndrome, adult congenital heart disease with HF, and patients with right HF. Also, patients with a history of chemo‐/radiotherapy for cancer or haematological malignancies need specific pre‐, during and post‐pregnancy assessment and counselling. We summarize the current knowledge about pathophysiological mechanisms, including gene mutations, clinical presentation, diagnosis, and medical and device management, as well as risk stratification. Women with a known diagnosis of a cardiomyopathy will often require continuation of drug therapy, which has the potential to exert negative effects on the foetus. This position paper assists in balancing benefits and detrimental effects.

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Section: Pathophysiology Of Heart Failure In Genetic Idiopathic and Cardiotoxic Therapy‐related Cardiomyopathies And Its Impact On The Pementioning

confidence: 99%

Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

Sliwa

Meer

Petrie

et al. 2021

European J of Heart Fail

View full text Add to dashboard Cite

show abstract

“…Pregnancy is known to challenge the cardiovascular system with changes in cardiac output that can cause decompensation in women with established heart disease . Case reports have described both dilated cardiomyopathy in pregnancy and peripartum cardiomyopathy in women previously treated with doxorubicin . In a case series of 37 pregnant women with a history of treatment with doxorubicin in childhood, there were three admissions with cardiac deterioration in pregnancy involving two women (one woman was admitted with deterioration in both of her pregnancies) .…”

Section: Impact On Maternal Healthmentioning

confidence: 99%

“…13 Case reports have described both dilated cardiomyopathy in pregnancy and peripartum cardiomyopathy in women previously treated with doxorubicin. 14,15 In a case series of 37 pregnant women with a history of treatment with doxorubicin in childhood, there were three admissions with cardiac deterioration in pregnancy involving two women (one woman was admitted with deterioration in both of her pregnancies). 16 In this study, there was a trend towards worsening fractional shortening on echocardiograms in those women who already had fractional shortening less than 30% before pregnancy, but this was not significant.…”

Section: Cardiovascularmentioning

confidence: 99%

Pregnancy following treatment for malignancy

Wallace

Swallow

2016

The Obstetric & Gynaecologis

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Key content Increasing numbers of women are surviving cancer in childhood or early adulthood. Treatments for malignancy can cause long‐term damage to a number of organs; this is frequently unappreciated by both patients and obstetricians. Pregnancy in women who have been exposed to treatments for cancer can be potentially problematic but most have a good outcome. A good understanding and initial assessment optimises the outcome for this group of women. Learning objectives To understand the implications of previous cancer treatments. To be able to plan management for this group of women in pregnancy. Ethical issues Should young survivors of malignancy be given improved information on the potential deleterious effects that their, often life‐saving, treatment has had on other body systems? Should all female survivors of malignancy be offered routine prepregnancy counselling?

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Pregnancy-associated cardiomyopathy in survivors of childhood cancer

et al. 2015

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Purpose Current information regarding pregnancy-associated cardiomyopathy among women treated for childhood cancer is insufficient to appropriately guide counseling and patient management. This study aims to characterize its prevalence within a large cohort of females exposed to cardiotoxic therapy. Methods Retrospective cohort study of female cancer survivors treated at St. Jude Children’s Research Hospital between 1963 and 2006, at least 5 years from diagnosis, ≥ 13 years old at last follow-up, and with at least one successful pregnancy. Pregnancy-associated cardiomyopathy was defined as shortening fraction < 28% or ejection fraction < 50% or treatment for cardiomyopathy during or up to 5 months after completion of pregnancy. Results Among 847 female cancer survivors with 1554 completed pregnancies only 3 (0.3%) developed pregnancy-associated cardiomyopathy, 40 developed non-pregnancy-associated cardiomyopathy either 5 months post-partum (n=14), or prior to pregnancy (n=26). Among those with cardiomyopathy prior to pregnancy (n=26), cardiac function deteriorated during pregnancy in 8 patients (3 patients with normalization of cardiac function prior to pregnancy, 3 with persistently abnormal cardiac function, and 2 for whom resolution of cardiomyopathy was unknown prior to pregnancy). Patients that developed cardiomyopathy recevied a higher median dose of anthracyclines compared to those that did not (321 mg/m2 versus 164 mg/m2; p< 0.01). Conclusions Pregnancy-associated cardiomyopathy in childhood cancer survivors is rare. Implications for cancer survivors Most female childhood cancer survivors will have no cardiac complications during or after childbirth, however those with a history of cardiotoxic therapies should be followed carefully during pregnancy particularly those with a history of anthracycline exposures and if they had documented previous or current subclinical or symptomatic cardiomyopathy. Female childhood cancer survivors with a history of cardiotoxic therapies should be followed carefully during pregnancy particularly those with a history of anthracycline exposures and if they had documented previous or current subclinical or symptomatic cardiomyopathy.

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Peripartum Cardiomyopathy Occurring in a Patient Previously Treated With Doxorubicin

Cited by 10 publications

References 12 publications

Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

Pregnancy following treatment for malignancy

Pregnancy-associated cardiomyopathy in survivors of childhood cancer

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