Work

Elevated Activin-A serum levels in patients with acute peripartum cardiomyopathy and during left ventricular recovery

Year: 2026

Type: article

Abstract: BACKGROUND AND AIMS: Peripartum cardiomyopathy (PPCM) is an idiopathic form of heart failure occurring 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 (404 pg/ml; interquartile range [IQR]: 197-815, n = 151) compared to healthy postpartum controls (240 pg/ml, IQR:148-446, n = 27; P < .01) and remained persistently elevated above postpartum healthy controls at 3 M (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 = .2416, n = 139), NT-proBNP (r = 0.096, P = .2766, n = 131), CRP (r = -0.0008, P = .9933; n = 110) or PPCM biomarker plasminogen-activator-inhibitor-1 (PAI-1) (r = 0.095, P = .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 < .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.

Source: ESC Heart Failure

DOI: 10.1093/eschf/xvag062