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High sFlt-1 levels correlate with increased PPCM risk in postpartum womenHigh sFlt-1 Levels Linked to Risk of Heart Failure

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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.

Researchers looked at the relationship between a specific protein called sFlt-1 and peripartum cardiomyopathy (PPCM). PPCM is a rare condition where the heart muscle weakens during the time around childbirth. The study included 226 women who were either pregnant or had recently given birth.

The findings show that higher levels of this protein are linked to an increased risk of heart problems. This link was even stronger in women who also had pre-eclampsia, a pregnancy complication involving high blood pressure. While the protein showed some ability to identify the condition, its overall diagnostic performance was only modest.

It is important to note that these results come from a small number of studies and show an association rather than a direct cause. Because the measurements were taken after birth, this test cannot currently be used to screen for heart issues during pregnancy. These findings are still early and exploratory due to how rare the condition is.

What this means for you:
High sFlt-1 levels are linked to heart risk after birth, especially in women with pre-eclampsia.

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).
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