Patients with peripartum cardiomyopathy (PPCM) were more likely to have cancer before PPCM diagnosis and more likely to develop cancer after PPCM when compared with cancer prevalence rates of women in the same age group, according to a study published Dec. 17 in JACC: CardioOncology.

Tobias J. Pfeffer, MD, et al., studied 236 German and Swedish PPCM patients. Exome sequencing assessed variants in 133 genes associated with cancer predisposition syndromes (CPS) and in 115 genes associated with dilated/hypertrophic cardiomyopathy (DCM/HCM) in 14 PPCM patients with a history of cancer, and in six PPCM patients without a history of cancer.

Researchers saw a 9-fold higher cancer occurrence prior to diagnosis of PPCM and a 9-fold higher risk of cancer after diagnosis of PPCM compared to age-matched women without PPCM. Cancer before PPCM occurred in 12 of 21 patients, 11 of whom obtained cardiotoxic cancer therapies. Full recovery of cardiac function was observed in 17 percent of these patients by 7 ± 2 months of follow-up vs. 55 percent of PPCM patients without cancer. Cancer occurred after PPCM in 10 of 21 patients and 80 percent had left ventricular ejection fraction of ≥50 percent after cancer therapy.

According to the researchers, their findings show cancer therapy and/or gene variants associated with cancer predisposition syndromes and dilated/hypertrophic cardiomyopathy may link PPCM and cancer. They recommend pre-pregnancy echocardiographic screening and counseling as well as close monitoring during pregnancy and postpartum for patients with a history of cancer and especially for patients treated with cardiotoxic cancer therapy. They add that PPCM patients should also be screened for cancer during follow-up, due to their increased risk.

In an accompanying editorial comment, Jean-Luc Balligand, MD, PhD, notes, "These observations may well have far-reaching implications, not only for the understanding of the pathogenic mechanisms of PPCM and cancer development in patients with heart failure, but also for the clinical care of women with a history of PPCM or cancer who become pregnant."

Don't miss Advancing the Cardiovascular Care of the Oncology Patient, held Feb. 14-16, 2020, at the Ritz-Carlton, Washington, DC. Led by Course Directors Ana Barac, MD, PhD, FACC, and Bonnie Ky, MD, MSCE, FACC, the overall goal of the course is to provide clinically relevant, state-of-the-art, best practice strategies for the interprofessional team in the assessment, diagnosis and management of cardiovascular concerns for patients with cancer and/or those requiring survivorship care. Register today.

Clinical Topics: Cardio-Oncology, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Acute Heart Failure, Echocardiography/Ultrasound

Keywords: Pregnancy, Peripartum Period, Syndrome, Stroke Volume, Exome, Cardiomyopathy, Dilated, Cardiomyopathies, Echocardiography, Cardiomyopathy, Hypertrophic, Heart Failure, Postpartum Period, Neoplasms, Cardiotoxicity

< Back to Listings