Verhoogd Activine-A bij peripartum cardiomyopathie en tijdens LV-herstel

AIM: Peripartum cardiomyopathy (PPCM) is an idiopatic form of heart failure occuring in the peripartum phase. Elevated circulating levels of the senescence-associated-secretory-phenotype (SASP) factor Activin-A have been associated with heart failure severity in acute PPCM patients at baseline diagnosis. Here, we investigated Activin-A serum levels in the German PPCM registry in acute PPCM and during left ventricular (LV) recovery. METHODS AND RESULTS: Clinical data including LV ejection fraction (LVEF) and Activin-A serum levels were assessed at initial diagnosis (baseline [BL], ) and during follow-up (FU) at 3 months (M) and 6M in PPCM patients from the German PPCM Registry (n=151, mean age 33±5 years) compared to postpartum healthy controls (n=27, mean age 32±5 years). Activin-A serum levels at BL were elevated (404pg/ml; interquartile range [IQR]: 197-815, n=151) compared to healthy postpartum controls (240 pg/ml, IQR:148-446, n=27; P<0.01) and remained persistently elevated above postpartum healthy controls at 3M (418 pg/ml, IQR: 169-806, n=100) and 6M-FU (520 pg/ml, IQR: 214-1131, n=104). Activin-A levels at BL did not correlate with LVEF (Spearman r=0.10, p=0.2416, n=139), NT-proBNP (r=0.096, p=0.2766, n=131), CRP (r=-0.0008, p= 0.9933; n=110) or PPCM biomarker plasminogen-activator-inhibitor-1 (PAI-1) (r=0.095, p=0.3273, n=109). The majority of PPCM patients showed LV recovery 6M after initial diagnosis, indicated by improved LVEF (PPCM BL: 25%, IQR: 20-33, n=152; 6M-FU: 52% IQR: 45-56, n=128, P<0.0001). Activin-A levels did not differ between full or incomplete LV recovery, or between patients with hypertensive pregnancy disorders. CONCLUSIONS: In PPCM patients from the German PPCM registry Activin-A serum levels were elevated at diagnosis, remained persistently high after 3M- and 6M-FU but were not associated with LV recovery.