Soluble fms-like tyrosine kinase-1 and peripartum cardiomyopathy: an exploratory meta-analysis of association and diagnostic performance.

Introduction: Peripartum 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. Methods: We 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). Results: Three studies ( Conclusion: Elevated 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 Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024535557, identifier (CRD42024535557).