Peripartum cardiomyopathy (PPCM) is specifically associated with which biomarker that reflects prolactin-mediated cardiac injury?
- A NT-proBNP
- B 16-kDa cleaved prolactin fragment ✓
- C Troponin I
- D Soluble Flt-1
Correct answer: B. 16-kDa cleaved prolactin fragment
Explanation
The Hilfiker-Kleiner hypothesis proposes that a 16-kDa N-terminal fragment of prolactin (cleaved by cathepsin D in a stress-oxidative environment) is the key pathological mediator in PPCM. This fragment is antiangiogenic, proapoptotic, and proinflammatory specifically in cardiomyocytes. This forms the rationale for bromocriptine (dopamine agonist, prolactin blocker) as a disease-modifying therapy in PPCM, which has been supported by the ZADERA trial. NT-proBNP and troponin I are markers of heart failure severity, not specific pathomechanistic mediators.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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