Heart Institute Expands Cardio-Oncology Services

Joining the Heart Institute at UPMC Children’s Hospital of Pittsburgh in August 2018, Kirsten Rose-Felker, MD, is a specialist in the field of Heart Failure and Transplantation with a special career and research interest in cardio-oncology. Cardiac dysfunction in children and adolescents who have been treated for cancer is a major cause of morbidity and mortality in this growing population.

Mitigating the cardiovascular dysfunction that can arise as a late-effect of cancer treatment is a major focus of Dr. Rose-Felker’s clinical work and research.

Dr. Rose-Felker completed her medical degree at the George Washington University School of Medicine in 2010 and continued her training with a Pediatric residency at Northwestern University followed by fellowships in both Pediatric Cardiology (2017) and Pediatric Heart Failure and Transplant (2018), both at Children’s Healthcare of Atlanta at Emory University.

“Joining UPMC Children’s will allow me to pursue my work in heart failure and transplant in one of the best transplant programs in the country. UPMC Children’s was also very willing to support my interest in cardiooncology and to help build and expand this program to treat this growing patient population,” says Dr. Rose-Felker.

Cardio-Oncology: A Growing Need in Patient Care

Pediatric oncology patients can face a cruel consequence of their treatments: heart disease and cardiac dysfunction that results from the systemic therapies necessary to treat or cure their cancer. There can be myriad other late effects of cancer treatment, but cardiovascular disease is the leading cause of morbidity and mortality in these patients outside of a secondary cancer or recurrence. “Cancer care has progressed so much over the last 30 years. Decades ago, many of these children would not have survived long enough for heart disease to manifest as a late effect of treatment. That equation has completely changed now,” says Dr. Rose-Felker. “Unfortunately, as cardiologists, we often see these patients too late — when irreversible damage has been done and their now limited treatment options include cardiac transplant. By seeing high risk patients sooner, we hope to provide them with better options and a longer life.”

Who’s at the Highest Risk for Cardiac Complications?

Dr. Rose-Felker is a proponent for a more integrated approach between oncology and cardiology to better identify the highest risk patients and get them into treatment to change outcomes. “Patients with certain types of aggressive childhood cancers which require the use of high-dose anthracyclines as part of the treatment regimen are amongst those at greatest risk of heart-related issues given the cardiotoxicity of this class of chemotherapy. These patients require close surveillance by their oncology team and proactive management by a cardiologist when changes are identified.”
Patients who have experienced radiation therapy involving the chest cavity have unique cardiovascular risk factors. Those with more traditional cardiovascular risk factors including hypertension, obesity, and diabetes, even if these comorbidities also are late effects, are at increased risk for cardiac complications.

Pathways to Cardiac Dysfunction

With respect to the heart muscle itself, the limited regenerative capacity of cardiomyocytes and the unique metabolic demands of the heart muscle, including its high tissue oxygen consumption, place it at disproportionate risk after cancer therapy when compared to other organs. “Anthracyclines cardiotoxic effects include interference with DNA and RNA synthesis and generation of oxygen free radicals which are particularly toxic to the abundance of mitochondria in cardiomyocytes,” says Dr. Rose-Felker.

Treating a Difficult to Treat Patient Population

It takes a collaborative approach to manage this patient population, one where cardiologists and oncologists work together to refer the most appropriate patients who are likely at highest risk based on their treatment regimens, type of cancer, and other comorbidities. Dr. Rose-Felker is actively working with colleagues from the Division of Hematology/Oncology to develop relationships and create the appropriate referral patterns. “Dr. Jean Tersak in the Pediatric Cancer Survivorship Clinic, and the leaders of the Heart Institute have been incredibly helpful in getting these conversations started. Our goal is to change the future of our hospital’s cancer survivors most at risk for cardiac complications.”

Recent Publications

A sample of recent publications from Dr. Rose-Felker includes:

Rose-Felker K, Mukhtar A, Kelleman MS, Deshpande SR, Mahle WT. Neutropenia in Pediatric Heart Transplant Recipients. Pediatr Transplant. 2018; 22(3). Epub ahead of print.

Rose-Felker K, Robinson JD, Backer CL, Rigsby CK, Eltayeb OM, Monge MC, Rychlik K, Sammet CL, Gossett JG. Preoperative Use of CT Angiography in Infants With Coarctation of the Aorta. World J Pediatr Congenit Heart Surg. 2017; 8(2): 196-202. 

Rose-Felker K, Border WL, Hong BJ, Chow EJ. Cardio-oncology Related to Heart Failure: Pediatric Considerations for Cardiac Dysfunction. Heart Failure Clin. 2017; 13(2): 311-325. 

Rose-Felker K, Kelleman MS, Campbell RM, Sachdeva R. Appropriateness of Outpatient Echocardiograms Ordered by Pediatric Cardiologists or Other Clinicians. J Pediatr. 2017; 184: 137-142. 

Rose-Felker K, Kelleman MS, Campbell RM, Oster ME, Sachdeva R. Appropriate Use and Clinical Impact of Echocardiographic Evaluation of Murmur in Pediatric Patients. Congenit Heart Dis. 2016; 11(6): 721-726.