P14 Use of bromocriptine for the treatment of peripartum cardiomyopathy: a meta-analysis of randomized controlled trials

Abstract

Background Peripartum cardiomyopathy is a rare, pregnancy associated cause of left ventricular heart failure in previously healthy women. It remains an important cause of cardiac-related maternal morbidity and mortality worldwide. Half of the patients will recover left ventricular function after 6 months. However, in the remainder of patients who do not recover cardiac function, they will require advanced heart failure therapies. Bromocriptine, a dopamine agonist which inhibits prolactin release, has demonstrated improvement in left ventricular recovery and clinical outcome. We sought to determine the effect of adding Bromocriptine to standard heart failure therapy on the improvement and recovery of left ventricular function of these patients. Inclusion Criteria. Studies were included if they satisfied the following criteria:1) Randomized Controlled Trials; 2) Pregnant patients who fulfilled the criteria for diagnosis of peripartum cardiomyopathy and 3) Reported data on improvement in left ventricular ejection fraction and clinical outcomes. Methods Using PUBMED, Clinical Key, Science Direct, Scopus, and Cochrane databases, a search for eligible studies was conducted from June to December 31, 2018. The quality of each study was evaluated using the Cochrane Risk of Bias Tool. The primary outcome of interest is on the effect of Bromocriptine on the improvement of left ventricular function and clinical outcomes among these patients. Review Manager 5.3 was utilized to perform analysis of random effects for continuous outcomes. Results We identified 2 randomized controlled trials of 58 pregnant patients diagnosed with peripartum cardiomyopathy, showing that among those who received Bromocriptine on top of standard heart failure therapy, there is a significant improvement in the left ventricular ejection fraction at 6 months [mean difference 15.14 (95% CI, 6.53 to 23.75) p <0.05] compared to standard heart failure therapy alone. It was also observed that those who received Bromocriptine had better clinical outcomes. Conclusion The addition of Bromocriptine on top of standard heart failure therapy significantly improved the left ventricular ejection fraction of patients with peripartum cardiomyopathy at 6 months post-partum. This novel therapy may be considered to improve the management of these patients.

Bromocriptine therapy: Review of mechanism of action, safety and tolerability

“…102,[107][108][109][110] Such addition of bromocriptine to HF general therapy shows greater improvement in the left ventricular ejection fraction (LVEF) at 6-month follow-up treatment as compared to that of standard heart failure (HF) therapy alone, and most of the patients recover from functional class III-IV to class I according to the NYHA functional classification. [111][112][113] Recent publications verified the effectiveness of bromocriptine therapy in patients with refractory cardiogenic shock complicating PPCM 114 and PPCM with right ventricular dysfunction as well. 115 In addition to prolactin inhibition, prolactinindependent cytoprotective effects of bromocriptine have also been revealed in various organs including the heart.…”

“…Prolactin release inhibition resulting in the reduction of 16‐kDa fragment with short‐term or even long‐term bromocriptine therapy, in addition to standard treatment for heart failure, is seen to be associated with increased recovery rate and negligibly low adverse outcome in patients with severe forms of PPCM, even no death and need of left ventricular assist device (LVAD) or heart transplantation have been observed 102,107–110 . Such addition of bromocriptine to HF general therapy shows greater improvement in the left ventricular ejection fraction (LVEF) at 6‐month follow‐up treatment as compared to that of standard heart failure (HF) therapy alone, and most of the patients recover from functional class III‐IV to class I according to the NYHA functional classification 111–113 . Recent publications verified the effectiveness of bromocriptine therapy in patients with refractory cardiogenic shock complicating PPCM 114 and PPCM with right ventricular dysfunction as well 115 .…”