Alexandre Mebazaa1,2,3, Marie-France Seronde1,4, Etienne Gayat1,2,3, Kemi Tibazarwa5,6, Dilly O C Anumba7, Najla Akrout1,3, Malha Sadoune1,2, Jamela Sarb7, Mattia Arrigo1,3, Justina Motiejunaite1,3, Said Laribi1,8, Matthieu Legrand1,2,3, Lydia Deschamps9, Loubina Fazal1,2, Lila Bouadma10, Corinne Collet11, Philippe Manivet1,11, Alain Cohen Solal1,2,12, Jean-Marie Launay1,11,13, Jane-Lise Samuel1,2,3, Karen Sliwa5,6. 1. UMR-S 942 INSERM, Lariboisière Hospital. 2. Paris Diderot University, Sorbonne Paris Cité. 3. Department of Anaesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris. 4. Department of Cardiology EA3920, University Hospital Jean Minjoz. 5. Hatter Institute for Cardiovascular Research in Africa and MRC Inter-Cape Heart Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town. 6. Soweto Cardiovascular Research Unit, University of the Witwatersrand. 7. Gynecology, Obstetric, Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield Medical School. 8. Department of Emergency Medicine, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris. 9. Department of Pathology, Bichat Hospital, AP-HP. 10. Department of Medical ICU, Bichat Hospital, AP-HP. 11. Biochemistry Department, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris. 12. Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris. 13. Paris Descartes University.
Abstract
BACKGROUND: 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). CONCLUSIONS: Plasma of PPCM patients shows imbalanced angiogenesis. High PlGF and/or low sFlt-1/PlGF may be used to diagnose PPCM.
BACKGROUND: 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). CONCLUSIONS: Plasma of PPCM patients shows imbalanced angiogenesis. High PlGF and/or low sFlt-1/PlGF may be used to diagnose PPCM.
Authors: Martijn F Hoes; Zoltan Arany; Johann Bauersachs; Denise Hilfiker-Kleiner; Mark C Petrie; Karen Sliwa; Peter van der Meer Journal: Nat Rev Cardiol Date: 2022-01-11 Impact factor: 49.421
Authors: Karen Sliwa; Mark C Petrie; Peter van der Meer; Alexandre Mebazaa; Denise Hilfiker-Kleiner; Alice M Jackson; Aldo P Maggioni; Cecile Laroche; Vera Regitz-Zagrosek; Maria Schaufelberger; Luigi Tavazzi; Jolien W Roos-Hesselink; Petar Seferovic; Karin van Spaendonck-Zwarts; Amam Mbakwem; Michael Böhm; Frederic Mouquet; Burkert Pieske; Mark R Johnson; Righab Hamdan; Piotr Ponikowski; Dirk J Van Veldhuisen; John J V McMurray; Johann Bauersachs Journal: Eur Heart J Date: 2020-10-14 Impact factor: 29.983