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Article

A Retrospective Evaluation of Risk of Peripartum Cardiac Dysfunction in Survivors of Childhood, Adolescent and Young Adult Malignancies

1
School of Medicine, University of Notre Dame, Sydney 2010, Australia
2
Department of Cardiovascular Medicine, Alfred Hospital, Melbourne 3000, Australia
3
Central Clinical School, Faculty of Medicine, Monash University, Clayton 3168, Australia
4
Heart Failure Research Group, Baker Heart and Diabetes Research Institute, Prahran 3181, Australia
5
Department of Nursing, Peter MacCallum Cancer Centre, Melbourne 3000, Australia
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Centre for Biostatics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne 3000, Australia
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Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne 3000, Australia
8
Department of Clinical Pathology, University of Melbourne, Parkville, VIC 3000, Australia
9
Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne 3000, Australia
10
Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3000, Australia
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(8), 1046; https://doi.org/10.3390/cancers11081046
Received: 28 June 2019 / Revised: 10 July 2019 / Accepted: 11 July 2019 / Published: 24 July 2019
Long-term survivors of childhood, adolescent and young adult (AYA) malignancies with past exposure to potentially cardiotoxic treatments are at risk of peripartum cardiac dysfunction. Incidence and risk factors for peripartum cardiac dysfunction and maternal cardiac outcomes in this population were investigated. Eligible long-term survivors were aged <30 years at cancer diagnosis, with ≥1 pregnancy occurring ≥5 years after diagnosis. “Peripartum” cardiac events were defined as occurring within pregnancy or ≤5months after delivery. Cardiac events were classified “symptomatic” or “subclinical”. “Peripartum cardiomyopathy” (PPCM) was defined as symptomatic dysfunction without prior cardiac dysfunction. Of 64 eligible women, 5 (7.8%) had peripartum cardiac events: 3 symptomatic, 2 subclinical. Of 110 live births, 2 (1.8%, 95% CI 0.2–6.4) were defined as PPCM: Significantly greater than the published general population incidence of 1:3000 (p < 0.001), representing a 55-fold (95% CI 6.6–192.0) increased risk. Risk factor analyses were hypothesis-generating, revealing younger age at cancer diagnosis and higher anthracycline dose. Postpartum, cardiac function of 4 women (80%) failed to return to baseline. In conclusion, peripartum cardiac dysfunction is an uncommon but potentially serious complication in long-term survivors of paediatric and AYA malignancies previously treated with cardiotoxic therapies. Peripartum cardiac assessment is strongly recommended for at-risk patients. View Full-Text
Keywords: peripartum cardiomyopathy; anthracycline cardiotoxicity; late effects; cardiac dysfunction; radiotherapy; long-term survivors; pregnancy; malignancy peripartum cardiomyopathy; anthracycline cardiotoxicity; late effects; cardiac dysfunction; radiotherapy; long-term survivors; pregnancy; malignancy
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MDPI and ACS Style

Chait-Rubinek, L.; Mariani, J.A.; Goroncy, N.; Herschtal, A.; Wheeler, G.C.; Dwyer, M.K.; Seymour, J.F.; Campbell, B.A. A Retrospective Evaluation of Risk of Peripartum Cardiac Dysfunction in Survivors of Childhood, Adolescent and Young Adult Malignancies. Cancers 2019, 11, 1046. https://doi.org/10.3390/cancers11081046

AMA Style

Chait-Rubinek L, Mariani JA, Goroncy N, Herschtal A, Wheeler GC, Dwyer MK, Seymour JF, Campbell BA. A Retrospective Evaluation of Risk of Peripartum Cardiac Dysfunction in Survivors of Childhood, Adolescent and Young Adult Malignancies. Cancers. 2019; 11(8):1046. https://doi.org/10.3390/cancers11081046

Chicago/Turabian Style

Chait-Rubinek, Lori, Justin A. Mariani, Natalie Goroncy, Alan Herschtal, Greg C. Wheeler, Mary K. Dwyer, John F. Seymour, and Belinda A. Campbell. 2019. "A Retrospective Evaluation of Risk of Peripartum Cardiac Dysfunction in Survivors of Childhood, Adolescent and Young Adult Malignancies" Cancers 11, no. 8: 1046. https://doi.org/10.3390/cancers11081046

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