Dilly O. C. Anumba
Alain Cohen Solal
Karen Sliwa-Hahnle, Australian Catholic University
Mebazaa, A., Seronde, M., Gayat, E., Tibazarwa, K., Anumba, D. O, Akrout, N., Sadoune, M., Sarb, J., Arrigo, M., Motiejunaite, J., Laribi, S., Legrand, M., Deschamps, L., Fazal, L., Bouadma, L., Collet, C., Manivet, P., Solal, A. C, Launay, J., Samuel, J. & Sliwa-Hahnle, K. (2017). Imbalanced angiogenesis in peripartum cardiomyopathy: diagnostic value of placenta growth factor. Circulation Journal,81(11), T. Murohara. 1654-1661. Japan: Japanese Circulation Society. Retrieved from https://doi.org/10.1253/circj.CJ-16-1193
Concentrations of the anti-angiogenic factor soluble fms-like tyrosine kinase-1 (sFlt-1) are altered in peripartum cardiomyopathy (PPCM). In this study we investigated changes in the angiogenesis balance in PPCM.
Methods and Results:
Plasma concentrations of sFlt-1 and the pro-angiogenic placenta growth factor (PlGF) were determined in patients with PPCM during the post-partum phase (n=83), in healthy women at delivery (n=30), and in patients with acute heart failure (AHF; n=65). Women with cardiac failure prepartum or associated with any form of hypertension, including pre-eclampsia, were excluded. Compared with non-pregnant women, in women with AHF and PPCM, median PlGF concentrations were greater (19 [IQR 16–22] and 98 [IQR 78–126] ng/mL, respectively; P<0.001) and the sFlt-1/PlGF ratio was lower (9.8 [6.6–11.3] and 1.2 [0.9–2.8], respectively; P<0.001). The sFlt-1/PlGF ratio was lower in PPCM than in normal deliveries (1.2 [0.9–2.8] vs. 94.8 [68.8–194.1], respectively; P<0.0001). The area under the curve for PlGF (cut-off value: 50ng/mL) and/or the sFlt-1/PlGF ratio (cut-off value: 4) to distinguish PPCM from either normal delivery or AHF was >0.94. Median plasma concentrations of the anti-angiogenic factor relaxin-2 were lower in PPCM and AHF (0.3 [IQR 0.3–1.7] and 0.3 [IQR 0.3–1] ng/mL, respectively) compared with normal deliveries (1,807 [IQR 1,101–4,050] ng/mL; P<0.001).
Plasma of PPCM patients shows imbalanced angiogenesis. High PlGF and/or low sFlt-1/PlGF may be used to diagnose PPCM.
Mary MacKillop Institute for Health Research