Damp Julie, Givertz Michael M, Semigran Marc, Alharethi Rami, Ewald Gregory, Felker G Michael, Bozkurt Biykem, Boehmer John, Haythe Jennifer, Skopicki Hal, Hanley-Yanez Karen, Pisarcik Jessica, Halder Indrani, Gorcsan John, Rana Sarosh, Arany Zoltan, Fett James D, McNamara Dennis M
Division of Cardiovascular Medicine, Vanderbilt University, Nashville, Tennessee.
Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts.
JACC Heart Fail. 2016 May;4(5):380-8. doi: 10.1016/j.jchf.2016.01.004. Epub 2016 Mar 9.
This study explored the association of vascular hormones with myocardial recovery and clinical outcomes in peripartum cardiomyopathy (PPCM).
PPCM is an uncommon disorder with unknown etiology. Angiogenic imbalance may contribute to its pathophysiology.
In 98 women with newly diagnosed PPCM enrolled in the Investigation in Pregnancy Associated Cardiomyopathy study, serum was obtained at baseline for analysis of relaxin-2, prolactin, soluble fms-like tyrosine kinase 1 (sFlt1), and vascular endothelial growth factor (VEGF). Left ventricular ejection fraction (LVEF) was assessed by echocardiography at baseline and 2, 6, and 12 months.
Mean age was 30 ± 6 years, with a baseline of LVEF 0.35 ± 0.09. Relaxin-2, prolactin, and sFlt1 were elevated in women presenting early post-partum, but decreased rapidly and were correlated inversely with time from delivery to presentation. In tertile analysis, higher relaxin-2 was associated with smaller left ventricular systolic diameter (p = 0.006) and higher LVEF at 2 months (p = 0.01). This was particularly evident in women presenting soon after delivery (p = 0.02). No relationship was evident for myocardial recovery and prolactin, sFlt1 or VEGF levels. sFlt1 levels were higher in women with higher New York Heart Association functional class (p = 0.01) and adverse clinical events (p = 0.004).
In women with newly diagnosed PPCM, higher relaxin-2 levels soon after delivery were associated with myocardial recovery at 2 months. In contrast, higher sFlt1 levels correlated with more severe symptoms and major adverse clinical events. Vascular mediators may contribute to the development of PPCM and influence subsequent myocardial recovery. (Investigation in Pregnancy Associate Cardiomyopathy [IPAC]; NCT01085955).
本研究探讨了血管生成激素与围产期心肌病（PPCM）患者心肌恢复及临床结局之间的关联。
PPCM是一种病因不明的罕见疾病。血管生成失衡可能在其病理生理过程中起作用。
在妊娠相关心肌病研究中纳入的98例新诊断为PPCM的女性患者中，于基线时采集血清，用于分析松弛素-2、催乳素、可溶性fms样酪氨酸激酶1（sFlt1）和血管内皮生长因子（VEGF）。在基线、2个月、6个月和12个月时通过超声心动图评估左心室射血分数（LVEF）。
平均年龄为30±6岁，基线时LVEF为0.35±0.09。产后早期女性的松弛素-2、催乳素和sFlt1水平升高，但迅速下降，且与分娩至就诊的时间呈负相关。在三分位数分析中，较高的松弛素-2与较小的左心室收缩直径（p = 0.006）及2个月时较高的LVEF相关（p = 0.01）。这在产后不久就诊的女性中尤为明显（p = 0.02）。心肌恢复与催乳素、sFlt1或VEGF水平之间无明显关系。纽约心脏协会心功能分级较高（p = 0.01）和发生不良临床事件（p = 0.004）的女性sFlt1水平较高。
在新诊断为PPCM的女性中，产后不久较高的松弛素-2水平与2个月时的心肌恢复相关。相比之下，较高的sFlt1水平与更严重的症状及主要不良临床事件相关。血管介质可能在PPCM的发生发展中起作用，并影响随后的心肌恢复。（妊娠相关心肌病研究[IPAC]；NCT01085955）
