University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Pregnancy Hypertens. 2023 Dec;34:60-66. doi: 10.1016/j.preghy.2023.10.002. Epub 2023 Oct 16.
Activin A has been implicated in the pathogenesis of patients with chronic hypertension and heart failure as well as patients with hypertensive disorders of pregnancy (HDP). Whether activin A correlates with blood pressure in patients with peripartum cardiomyopathy (PPCM) and HDP history has not previously been explored.
82 women with PPCM w/ and w/out HDP or hypertension history were selected for analysis from the Investigations in Pregnancy Associated Cardiomyopathy (IPAC) study. Serum biomarkers and blood pressure were assessed at the time of enrollment (median postpartum day 24). Levels of both sFlt-1 (SBP: r 0.47, p = 0.008; DBP: r 0.57, p < 0.001) and activin A (SBP: r 0.59, p < 0.001;DBP: r 0.68, p < 0.001) were noted to significantly correlate with blood pressure in patients with a history of HDP who went on to develop PPCM, but not in patients with chronic hypertension or no hypertensive history. The strongest correlation was between activin A levels and postpartum diastolic blood pressure for the subset with preeclampsia (DBP: r0.82, p < 0.001). This remained significant in multivariable linear regression analysis (DBP: β = 0.011, p = 0.015).
In patients with PPCM, activin A and sFlt-1 levels had direct correlations with both systolic (SBP) and diastolic blood pressures (DBP), but only in participants with history of HDP. This correlation was more evident for activin A and strongest with a history of preeclampsia. Our findings suggest that activin A may play an important role in blood pressure modulation in women with HDP who subsequently develop PPCM.
激活素 A 与慢性高血压和心力衰竭患者以及妊娠高血压疾病（HDP）患者的发病机制有关。在患有围产期心肌病（PPCM）和 HDP 病史的患者中，激活素 A 是否与血压相关，目前尚未探讨。
从妊娠相关心肌病研究（IPAC）中选择了 82 名患有 PPCM 伴或不伴 HDP 或高血压病史的女性进行分析。在入组时（产后第 24 天中位数）评估血清生物标志物和血压。既往有 HDP 病史的患者发生 PPCM 后，sFlt-1（SBP：r0.47，p=0.008；DBP：r0.57，p<0.001）和激活素 A（SBP：r0.59，p<0.001；DBP：r0.68，p<0.001）的水平均与血压显著相关，但在患有慢性高血压或无高血压病史的患者中则不然。在子痫前期亚组中，激活素 A 水平与产后舒张压之间的相关性最强（DBP：r0.82，p<0.001）。多元线性回归分析结果仍有统计学意义（DBP：β=0.011，p=0.015）。
在患有 PPCM 的患者中，激活素 A 和 sFlt-1 水平与收缩压（SBP）和舒张压（DBP）均有直接相关性，但仅在有 HDP 病史的患者中存在。对于激活素 A 而言，这种相关性更为明显，与子痫前期病史的相关性最强。我们的研究结果表明，激活素 A 在随后发生 PPCM 的患有 HDP 的女性中可能在血压调节中发挥重要作用。
