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Women treated for cancer have higher CHF risk in pregnancy

Anthracycline-exposed women should receive close cardiac surveillance during pregnancy

Louise Prime

Tuesday, 16 October 2018

Women previously exposed to cardiotoxic cancer treatments who have had prior cardiotoxicity have an almost one in three chance of developing congestive heart failure (CHF) with pregnancy, researchers have reported* in the Journal of the American College of Cardiology. They recommend that these women should receive close cardiac surveillance during pregnancy.

The authors of this study pointed out that the American Cancer Society estimates that about 60,000 young men and women in the US are diagnosed with cancer each year – and women are in the majority. Previous research has shown an association between cancer treatments and heart disease in women of childbearing age.

They conducted a retrospective study of female cancer survivors who had been given potentially cardiotoxic cancer treatments, including chemotherapy or radiotherapy to the thorax, to investigate whether or not there was an association between a cardiotoxicity history and women’s risk of heart failure during or soon after pregnancy. They followed 78 cancer survivors attending a high-risk pregnancy clinic, who between them had 94 pregnancies (90 singletons and four twin pregnancies) over a 10-year period. All the women had had cancer therapy in childhood, adolescence or young adulthood.

They compared rates of adverse cardiac events (specifically cardiac death, CHF, acute coronary syndrome or arrhythmia) between those 55 women who had received anthracycline-based chemotherapy, and the 23 who had received non-anthracycline chemotherapy or radiation therapy only.

Of all 94 pregnancies, 15 (16%) were in 13 women with a prior history of cardiotoxicity, and 12 of these women had been treated with anthracycline-based chemotherapy. Almost a third (31%) of women with a history of cardiotoxicity suffered CHF during pregnancy or soon after delivery, with no reports of acute coronary syndrome or arrhythmia. The women diagnosed with CHF and those without did not differ in terms of their age of cancer diagnosis, age at pregnancy, cancer type or exposure to anthracyclines. There were no maternal deaths.

Previous studies have suggested that CHF occurs in young female cancer survivors at a rate anywhere between from 0 and 5.4%, but the current study authors noted that those studies had varied methods, which made it difficult to determine a single percentage; furthermore, some studies did not have pre- and post-pregnancy cardiac assessments (they relied on self-reporting), or they included extraneous events too far outside the pregnancy. They commented: “Our study followed the cardiac outcomes in consecutive pregnancies of cancer survivors. We collected data on any cardiac events occurring immediately before, during and after pregnancy. From this streamlined approach, we could pinpoint just how high the risk of developing CHF was for young, pregnant women exposed to anthracyclines.”

The researchers concluded: “For women without a history of cardiotoxicity, their risk of developing CHF during pregnancy is very low. However, for women who have been exposed to cardiotoxic treatments and have had prior cardiotoxicity, there’s approximately a one in three chances of developing CHF with pregnancy. These women should receive close cardiac surveillance during pregnancy.”

* Liu S, Aghel N, Belford L, et al. Cardiac outcomes in pregnant women with treated cancer. Journal of the American College of Cardiology Oct 2018, 72 (17) 2087-2089; DOI: 10.1016/j.jacc.2018.07.085.

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