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PPCM pathogenesis involves multiple putative mechanisms including inflammation. We aimed to explore the acute inflammatory processes in PPCM using 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18FDG-PET-CT), cardiovascular magnetic resonance (CMR), and inflammasome profiling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Women with a new diagnosis of PPCM (n\u2009=\u200910, all within 3\u2009months postpartum), five healthy postpartum controls (HPC), and five healthy non-postpartum controls (HNPC), underwent 18FDG-PET-CT, CMR, and serum inflammatory proteomic profiling. PPCM patients had a median age of 34\u2009years (interquartile range [IQR] 30.3\u201338.5, similar in control groups), and a median parity of 3 (IQR 1\u20134). PPCM patients presented with severe, symptomatic heart failure (all New York Heart Association functional class III\/IV), reduced median left ventricular ejection fraction of 35.5% (IQR 18.1\u201337.9). PPCM and HPC groups showed higher myocardial and splenic 18FDG uptake compared to HNPC. On CMR, myocardial interstitial fibrosis (elevated T1 time, extracellular volume, and late gadolinium enhancement mass) was solely present in PPCM. Inflammatory profiling showed pro-inflammatory cytokine dysregulation in PPCM (elevated neutrophil-to-lymphocyte ratio, C-reactive protein, interleukin-6, tumour necrosis factor-\u03b1, chemokine (C-C motif) ligand 3, hepatocyte growth factor, chemokine (C-X-C motif) ligand 10 and colony-stimulating factor-1) compared to controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with PPCM exhibited a dysregulated immune response, associated with early myocardial interstitial fibrosis and adverse cardiac remodelling. This highlights the importance of rapid initiation of guideline-directed medical therapy especially with drugs documented to have anti-fibrotic effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.3759","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T10:35:11Z","timestamp":1752489311000},"page":"1868-1880","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Immune Dysregulation as a Key Driver of Peripartum Cardiomyopathy \u2013 an Exploratory Advanced Imaging and Biomarker Study"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2023-3026","authenticated-orcid":false,"given":"Julian","family":"Hoevelmann","sequence":"first","affiliation":[{"name":"Cape Heart Institute, Faculty of Health Sciences, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"Department of Internal Medicine III - Cardiology, 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University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petronella","family":"Samuels","sequence":"additional","affiliation":[{"name":"Cape Universities Body Imaging Centre, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Briton","sequence":"additional","affiliation":[{"name":"Cape Heart Institute, Faculty of Health Sciences, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynette","family":"Cilliers","sequence":"additional","affiliation":[{"name":"Department of Dietetics, Groote Schuur Hospital , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Hilfiker-Kleiner","sequence":"additional","affiliation":[{"name":"Institute Cardiovascular Complications in Pregnancy and Oncologic Therapies, Philipps University Marburg , Marburg ,","place":["Germany"]},{"name":"President of the Hannover Medical School , Hannover ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"van der Meer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Groningen, University of Groningen , Groningen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"B\u00f6hm","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Saarland University , Homburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ntobeko A.B.","family":"Ntusi","sequence":"additional","affiliation":[{"name":"Cape Heart Institute, Faculty of Health Sciences, University of Cape Town , Cape Town 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