| Autor: |
Tobias J. Pfeffer, MD, Stella Schlothauer, MS, Stefan Pietzsch, PhD, Maria Schaufelberger, MD, Bernd Auber, MD, Melanie Ricke-Hoch, PhD, Manuel List, MS, Dominik Berliner, MD, Valeska Abou Moulig, MD, Tobias König, MD, Zolt Arany, MD, PhD, Karen Sliwa, MD, Johann Bauersachs, MD, Denise Hilfiker-Kleiner, PhD |
| Jazyk: |
angličtina |
| Rok vydání: |
2019 |
| Předmět: |
|
| Zdroj: |
JACC. CardioOncology, Vol 1, Iss 2, Pp 196-205 (2019) |
| Druh dokumentu: |
article |
| ISSN: |
2666-0873 |
| DOI: |
10.1016/j.jaccao.2019.09.008 |
| Popis: |
Objectives: This study was designed to analyze the prevalence and potential genetic basis of cancer and heart failure in peripartum cardiomyopathy (PPCM). Background: PPCM manifests as heart failure late in pregnancy or postpartum in women without previous heart disease. Methods: Clinical history and cancer prevalence were evaluated in a cohort of 236 PPCM patients from Germany and Sweden. 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 6 PPCM patients without a history of cancer. Results: The prevalence of cancer was 16-fold higher (8.9%, 21 of 236 patients) in PPCM patients compared to age-matched women (German cancer registry, Robert-Koch-Institute: 0.59%; p < 0.001). Cancer before PPCM occurred in 12 of 21 patients of whom 11 obtained cardiotoxic cancer therapies. Of those, 17% fully recovered cardiac function by 7 ± 2 months of follow-up compared to 55% of PPCM patients without cancer (p = 0.015). Cancer occurred after PPCM in 10 of 21 patients; 80% had left ventricular ejection fraction of ≥50% after cancer therapy. Whole-exome sequencing in 14 PPCM patients with cancer revealed that 43% (6 of 14 patients) carried likely pathogenic (Class IV) or pathogenic (Class V) gene variants associated with DCM/HCM in CPT2, DSP, MYH7, TTN, and/or with CPS in ATM, ERCC5, NBN, RECQL4, and SLX4. All CPS variants affected DNA damage response genes. Conclusions: Cardiotoxic cancer therapy before PPCM is associated with delayed full recovery. The high cancer prevalence in PPCM is linked to likely pathogenic/pathogenic gene variants associated with DCM/HCM and/or CPS/DNA damage response–related cancer risk. This may warrant genetic testing and screening for heart failure in pregnant women with a cancer history and screening for cancer in PPCM patients. |
| Databáze: |
Directory of Open Access Journals |
| Externí odkaz: |
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