Cancer risk elevated in peripartum cardiomyopathy
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Women with peripartum cardiomyopathy have a 16 times greater prevalence of cancer compared with those who do not, and cancer incidence was associated with greater delay in recovery of cardiac function, according to findings published in JACC: CardioOncology.
Using data from the German cancer registry of the Robert Koch Institute, researchers observed that cancer prevalence was 16-fold higher (8.9%; 21 of 236 patients) for patients with peripartum cardiomyopathy compared with age-matched women (0.59%; P < .001). Of the women who developed cancer, 17% fully recovered cardiac function by approximately 7 months follow-up compared with 55% of patients with peripartum cardiomyopathy without cancer (P = .015).
Of the 21 women who developed cancer before peripartum cardiomyopathy, 11 underwent some form of cardiotoxic cancer therapy, according to the study.
Moreover, cancer after peripartum cardiomyopathy occurred in 10 of the 21 patients, 80% of whom had a left ventricular ejection fraction of at least 50% after cancer therapy.
“This study is the first to describe a markedly increased risk for malignancies both before and after the diagnosis of peripartum cardiomyopathy,” Denise Hilfiker-Kleiner, PhD, of the department of cardiology and angiology at the Hannover Medical School, Hannover, Germany, and colleagues wrote. “The type of cancer, the cancer therapy and/or gene variants associated with dilated/hypertrophic cardiomyopathy and/or with cancer predisposition syndromes/DNA damage response may connect peripartum cardiomyopathy and cancer.”
In other findings, whole-exome sequencing among 14 patients with peripartum cardiomyopathy and cancer revealed that 43% carried likely class IV or class V pathogenic gene variants associated with dilated/hypertrophic cardiomyopathy in carnitine palmitoyltransferase II, DSP, myosin heavy chain 7, tin and/or with cancer predisposition syndrome in ataxia telangiectasia mutated, excision repair cross-complementing rodent repair deficiency, nibrin, ATP-dependent DNA helicase Q4 and structure-specific endonuclease subunit SLX4. All cancer predisposition syndrome variants affected DNA damage response genes, according to the study.
Genetically predisposed patients
“Prepregnancy echocardiographic screening and counseling, together with close monitoring during pregnancy and postpartum, may be recommended for patients with a history of cancer and cancer therapy before pregnancy,” the researchers wrote. “In addition, as peripartum cardiomyopathy patients may have a higher (genetic) risk of developing cancer, they may require both regular cardiovascular and cancer screening as well as genetic screening for both diseases.”
Researchers evaluated medical records and cancer prevalence in 236 women (mean age, 34 years) with peripartum cardiomyopathy from Germany and Sweden. They performed exome sequencing in 14 patients with peripartum cardiomyopathy and a history of cancer, and six patients with peripartum cardiomyopathy without a history of cancer.
According to the study, exome sequencing assessed variants in 133 genes associated with cancer predisposition syndromes and 115 genes associated with dilated/hypertrophic cardiomyopathy.
“Further research in larger independent peripartum cardiomyopathy cohorts is needed to confirm both the higher prevalence of cancer in peripartum cardiomyopathy patients as well as the higher risk for peripartum cardiomyopathy as a late form of cardiotoxicity after cancer treatment,” the researchers wrote. “Moreover, experimental studies are needed to determine the potential pathologic impact of systemic DNA damage mutations (cancer predisposition syndromes/DNA damage response) not only for cancer but also for the development of peripartum cardiomyopathy. It is important to understand whether dilated/hypertrophic cardiomyopathy mutations leading to peripartum cardiomyopathy may also promote the early-onset cancer after peripartum cardiomyopathy.”
Monitoring supported
“These observations may well have far-reaching implications, not only for the understanding of the pathogenic mechanisms of peripartum cardiomyopathy and cancer development in patients with heart failure, but also for the clinical care of women with a history of peripartum cardiomyopathy or cancer who become pregnant,” Jean-Luc Balligand, MD, PhD, head of the Pole of Pharmacology and Therapeutics within Institute for Clinical and Experimental Research and practicing physician at the Cliniques Universitaires Saint-Luc, Brussels, wrote in a related editorial. “Despite small numbers, the data would support the close monitoring of left ventricular function in women with a history of cancer who become pregnant. Reciprocally, patients who develop peripartum cardiomyopathy should be followed up for the detection of cancer emergence.” – by Scott Buzby
Disclosures: The authors and Balligand report no relevant financial disclosures.
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