Author + information
- Mark Nolan, MBBS, PhDa,
- Evangelos K. Oikonomou, MDb,
- Candice K. Silversides, MDa,c@CandiceSilvers1,
- Melissa R. Hines, MDd,
- Kara A. Thompson, MDe,
- Belinda A. Campbell, MBBS, MMedf,
- Eitan Amir, MD, PhDg,
- Cynthia Maxwell, MDh and
- Paaladinesh Thavendiranathan, MD, SMa,i,∗ (, )@dineshpmcc1
- aDepartment of Medicine, Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- bDepartment of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
- cPregnancy and Heart Disease Program, Department of Medicine, Division of Cardiology, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada
- dDivision of Critical Care, St. Jude Children’s Research Hospital, Memphis, Tennessee
- eDepartment of Cardiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
- fDepartment of Radiation Oncology, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia, and Department of Clinical Pathology, The University of Melbourne, Parkville, Victoria, Australia
- gDivision of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- hDepartment of Obstetrics and Gynecology, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- iJoint 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.
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.
Dr. Thavendiranathan is supported by the Canadian Institutes of Health Research New Investigator Award. Dr. Nolan was compensated as a speaker for Novartis. Dr. Hines had a relationship with Incyte. Dr. Amir presented expert testimony for Genentech and Roche; and is a consultant for Sandoz and Apobiologix. Dr. Maxwell is a consultant for Guidepoint Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: CardioOncology author instructions page.
- Received November 5, 2019.
- Revision received April 8, 2020.
- Accepted April 11, 2020.
- 2020 The Authors