January 1, 2017Open Access
Imbalanced Angiogenesis in Peripartum Cardiomyopathy ― Diagnostic Value of Placenta Growth Factor ―
Structured PICO
Does the measurement of PlGF and the sFlt-1/PlGF ratio accurately diagnose peripartum cardiomyopathy compared to normal delivery or acute heart failure?
P
Population
178 women, including patients with peripartum cardiomyopathy (PPCM) during the post-partum phase (n=83), healthy women at delivery (n=30), and patients with acute heart failure (AHF; n=65). Excluded: women with cardiac failure prepartum or associated with any form of hypertension, including pre-eclampsia.
I
Intervention
Measurement of plasma concentrations of placenta growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), and relaxin-2
C
Comparator
Healthy women at delivery and non-pregnant women with acute heart failure (AHF)
O
Outcome
Diagnostic accuracy (Area Under the Curve) of PlGF and sFlt-1/PlGF ratio to distinguish PPCM from normal delivery or AHFsurrogate
High plasma PlGF and/or a low sFlt-1/PlGF ratio demonstrate high diagnostic accuracy for distinguishing peripartum cardiomyopathy from normal delivery or acute heart failure.
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; P0.94. 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.