High sFlt-1 levels correlate with increased PPCM risk in postpartum women

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Frontiers in Medicine Published June 8, 2026 Medically reviewed June 8, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Note that high sFlt-1 levels correlate with PPCM risk but cannot currently be used for antepartum screening.

This meta-analysis evaluates the association between circulating soluble fms-like tyrosine kinase-1 (sFlt-1) levels and the risk of peripartum cardiomyopathy (PPCM). The analysis synthesized data from 3 studies involving 226 participants to determine if sFlt-1 serves as a viable biomarker for PPCM, particularly in patients with pre-eclampsia.

Key findings indicate that high sFlt-1 levels are associated with increased PPCM risk (OR 1.79; 95% CI 1.22–2.64). The association was notably stronger in women with pre-eclampsia compared to those without (OR 2.11 [95% CI 1.45–3.09] vs OR 1.36 [95% CI 1.03–1.80]). However, the overall diagnostic performance of sFlt-1 was modest, with a sensitivity of 72%, specificity of 57%, and an AUC of 0.71.

The authors note several limitations, including substantial heterogeneity across studies and a small number of eligible studies. Crucially, because measurements were only taken in the postpartum period, these findings are not currently suitable for antepartum screening assessment. Clinical application is limited by the exploratory nature of this meta-analysis due to the rarity of the condition.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

IntroductionPeripartum cardiomyopathy (PPCM) is a rare cause of heart failure in late pregnancy and early postpartum, and biomarkers for risk stratification are lacking. Soluble fms-like tyrosine kinase-1 (sFlt-1), implicated in PPCM and pre-eclampsia, may be associated with PPCM and may have potential diagnostic relevance. This study aimed to evaluate the association between circulating sFlt-1 levels and PPCM and to provide an exploratory assessment of the diagnostic performance of sFlt-1 overall and according to pre-eclampsia status.MethodsWe searched PubMed, Europe PMC, and ScienceDirect from inception to 15th February 2026 for studies reporting sFlt-1 in PPCM cases and pregnant or postpartum controls. Given the rarity of PPCM and the limited number of eligible studies, this review was designed as an exploratory meta-analysis. Random-effects models pooled odds ratios (ORs) for PPCM comparing high vs. low sFlt-1 and enabled subgroup analyses by pre-eclampsia. I Diagnostic performance was summarised using pooled sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC).ResultsThree studies (n = 226) met the criteria. High sFlt-1 levels were associated with increased PPCM risk [pooled OR 1.79; 95% confidence interval (CI) 1.22–2.64], although substantial heterogeneity was present across studies. In exploratory diagnostic analyses, performance was modest, with sensitivity 72% (95% CI 64%–80%), specificity 57% (95% CI 44%–68%), and AUC 0.71 (95% CI 0.67–0.75). In women with pre-eclampsia, the association with PPCM was stronger (OR 2.11; 95% CI 1.45–3.09) than in those without pre-eclampsia (OR 1.36; 95% CI 1.03–1.80), with higher sensitivity and specificity.ConclusionElevated sFlt-1 was associated with PPCM, with exploratory analyses suggesting somewhat better diagnostic discrimination in women with pre-eclampsia. However, because all included studies measured sFlt-1 in the postpartum period, these findings should not be interpreted as evidence for antepartum screening utility. Larger prospective studies with measurements during pregnancy and serial peripartum follow-up are needed before any clinical application can be considered.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024535557, identifier (CRD42024535557).