title: Relaxin-2 and Soluble Flt1 Levels in Peripartum Cardiomyopathy: Results of the Multicenter IPAC Study.
abstract: 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).
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University, Nashville, Tennessee. Electronic address: julie.boyd@vanderbilt.edu.
authors.forename: Julie
authors.initials: J
authors.lastname: Damp
authors.affiliation: Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Marc
authors.initials: M
authors.lastname: Semigran
authors.affiliation: Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah.
authors.forename: Rami
authors.initials: R
authors.lastname: Alharethi
authors.affiliation: Division of Cardiology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Gregory
authors.initials: G
authors.lastname: Ewald
authors.affiliation: Division of Cardiology, Duke University, Durham, North Carolina.
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.affiliation: Section of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Biykem
authors.initials: B
authors.lastname: Bozkurt
authors.affiliation: Division of Cardiology, Penn State Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: John
authors.initials: J
authors.lastname: Boehmer
authors.affiliation: Division of Cardiology, Columbia University, New York, New York.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Haythe
authors.affiliation: Division of Cardiology, Stony Brook Medical Center, Stony Brook, New York.
authors.forename: Hal
authors.initials: H
authors.lastname: Skopicki
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Karen
authors.initials: K
authors.lastname: Hanley-Yanez
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jessica
authors.initials: J
authors.lastname: Pisarcik
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Indrani
authors.initials: I
authors.lastname: Halder
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: John
authors.initials: J
authors.lastname: Gorcsan
authors.affiliation: Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois.
authors.forename: Sarosh
authors.initials: S
authors.lastname: Rana
authors.affiliation: Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Arany
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: James D
authors.initials: JD
authors.lastname: Fett
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: McNamara
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000097:blood* / Q000503:physiopathology; D005260:Female; D006801:Humans; D011247:Pregnancy; D011379:Prognosis; D011388:Prolactin / Q000097:blood*; D011644:Puerperal Disorders / Q000097:blood* / Q000503:physiopathology; D020127:Recovery of Function; D012065:Relaxin / Q000097:blood*; D013318:Stroke Volume; D013997:Time Factors; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*; D055815:Young Adult
chemical_list: C095068:RLN2 protein, human; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D011388:Prolactin; D012065:Relaxin; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1
keywords: cardiomyopathy; heart failure; hormones; pregnancy and post-partum