Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec:34:60-66.
doi: 10.1016/j.preghy.2023.10.002. Epub 2023 Oct 16.

Association of activin A and postpartum blood pressure in peripartum cardiomyopathy

Agnes Koczo  1 , Amy Marino  2 , Vincenzo B Polsinelli  3 , Rami Alharethi  4 , Julie Damp  5 , Gregory Ewald  6 , Michael M Givertz  7 , John Boehmer  8 , Karen Hanley-Yanez  2 , Sarosh Rana  9 , Jason Roh  10 , Dennis M McNamara  2 ; IPAC Investigators
Affiliations

Association of activin A and postpartum blood pressure in peripartum cardiomyopathy

Agnes Koczo et al. Pregnancy Hypertens. 2023 Dec.

Abstract

Background: 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.

Methods and results: 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).

Conclusion: 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.

Keywords: Activin A; Hypertensive Disorders of Pregnancy; Peripartum Cardiomyopathy.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: SR reports serving as a consultant for Roche Diagnostics, Thermo Fisher, Beckman Coulter, Siemens, and has received research funding from Roche Diagnostics and Siemens for work related to angiogenic biomarkers that are unrelated to the submitted work.

Figures

Figure 1.
Figure 1.
Correlation of activin A levels by days postpartum for HDP cohort. Activin A levels decreased with number of days postpartum. HDP; Hypertensive disorders of pregnancy
Figure 2.
Figure 2.
Correlation of activin A levels and systolic blood pressure for PPCM population with preeclampsia. Activin A levels are strongly correlated with systolic blood pressure among patients with preeclampsia. PPCM, peripartum cardiomyopathy
Figure 3.
Figure 3.
Activin A levels and diastolic blood pressure for PPCM cohort with pre-eclampsia. Activin A levels are strongly correlated with diastolic blood pressures among patients with preeclampsia. PPCM, peripartum cardiomyopathy
See this image and copyright information in PMC

References

    1. Bello N, Rendon ISH, Arany Z. The relationship between pre-eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis. J Am Coll Cardiol. 2013. Oct 29;62(18):1715–1723. - PMC - PubMed
    1. McNamara DM, Elkayam U, Alharethi R, Damp J, Hsich E, Ewald G, Modi K, Alexis JD, Ramani GV, Semigran MJ, Haythe J, Markham DW, Marek J, Gorcsan J 3rd, Wu WC, Lin Y, Halder I, Pisarcik J, Cooper LT, Fett JD; IPAC Investigators. Clinical Outcomes for Peripartum Cardiomyopathy in North America: Results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy). J Am Coll Cardiol. 2015. Aug 25;66(8):905–14. - PMC - PubMed
    1. Ersbøll AS, Goetze JP, Johansen M, Hauge MG, Sliwa K, Vejlstrup N, Gustafsson F, Damm P. Biomarkers and Their Relation to Cardiac Function Late After Peripartum Cardiomyopathy. J Card Fail. 2021. Feb;27(2):168–175. - PubMed
    1. Lim S, Li W, Kemper J, Nguyen A, Mol BW, Reddy M. Biomarkers and the Prediction of Adverse Outcomes in Preeclampsia: A Systematic Review and Meta-analysis. Obstet Gynecol. 2021. Jan 1;137(1):72–81 - PubMed
    1. Shahul S, Ramadan H, Nizamuddin J, Mueller A, Patel V, Dreixler J, Tung A, Lang RM, Weinert L, Nasim R, Chinthala S, Rana S. Activin A and Late Postpartum Cardiac Dysfunction Among Women With Hypertensive Disorders of Pregnancy. Hypertension. 2018. Jul;72(1):188–193. - PubMed