understanding peripartum cardiomyopathy (PPCM)

[alviarin]

"Peripartum cardiomyopathy (PPCM) is an often fatal disease that affects pregnant women who are near delivery, and it occurs more frequently in women with pre-eclampsia and/or multiple gestation. The aetiology of PPCM, and why it is associated with pre-eclampsia, remain unknown. Here we show that PPCM is associated with a systemic angiogenic imbalance, accentuated by pre-eclampsia."
"...plasma samples from women with PPCM contained abnormally high levels of sFLT1."

http://www.nature.com/nature/journal/v4 ... 11040.html

"The study has harnessed significant causal evidence and arrived at a powerful argument that PPCM is a two-hit disease, with the first hit being the antiangiogenic environment of late pregnancy and the second hit being something as yet undiscovered that leaves women susceptible to cardiac damage, possibly an infection or genetic predisposition."

http://www.bidmc.org/News/InResearch/20 ... _PPCM.aspx

This study isn't about pre-eclampsia per se, but since pre-eclampsia is mentioned and we have had some posters who have suffered from PPCM I thought it would be good to share.

[caryn]

Ha! I was just talking to the Experts about this study. It looks to me like we might have a reason to think sFlt might be causing cardiac damage in preeclamptics, rather than pregnancy unmasking preexisting risk. Or something.

I don't understand the molecular mechanisms here well at all but no one does. One thing: *all* pregnant women have high sFlt at term, which is why it's hard to design a diagnostic test, and not all pregnant women develop cardiac damage.

Will keep poking at it.

[alviarin]

PPCM very well could be a "two-hit" process. Underlying genetic pre-disposition, whether a mutation on chromosone 12 http://intermountainhealthcare.org/hospitals/imed/about/news/Pages/home.aspx?NewsID=814 or a deficiency in PGC1-alpha like the knockout mice in the above study making some women overly sensitive to high sFLT1 levels. Which are even more elevated during pre-e pregnancies.

I still wonder if some of the long-term cardiovascular risks associated with pre-e could also be linked to hypothyroidism. Since sFLT1 also mucks with your thyroid gland and even subclinical hypothyroidism has been linked to increase in cardiovascular risk factors including high LDL cholesterol, high triglycerides, impaired myocardial contractility, diastolic dysfunction, and atherosclerosis.

[caryn]

I was thinking about placentas that turn off production of whatever they'd like, including inducing thyroid issues.

This will be interesting to watch.