The effect of bromocriptine on left ventricular functional recovery in peripartum cardiomyopathy: insights from the BRO‐HF retrospective cohort study

Abstract

AimsBromocriptine is thought to facilitate left ventricular (LV) recovery in peripartum cardiomyopathy (PPCM) through inhibition of prolactin secretion. However, this potential therapeutic effect remains controversial and was incompletely studied in diverse populations.Methods and resultsConsecutive women with new‐onset PPCM (n = 76) between 1994 and 2015 in Quebec, Canada, were classified according to treatment (n = 8, 11%) vs. no treatment (n = 68, 89%) with bromocriptine. We assessed LV functional recovery at mid‐term (6 months) and long‐term (last follow‐up) and compared outcomes among groups. Women treated with bromocriptine experienced better mid‐term left ventricular ejection fraction (LVEF) recovery from 23 ± 10% at baseline to 55 ± 12% at 6 months, compared with a change from 30 ± 12% at baseline to 45 ± 13% at 6 months in women treated with standard medical therapy (P interaction < 0.01). At long‐term, a similar positive association was found with bromocriptine (9% greater LVEF variation, P interaction < 0.01). In linear regressions adjusted for obstetrical, clinical, echocardiographic, and pharmacological variables, treatment with bromocriptine was associated with a greater improvement in LVEF [β coefficient (standard error), 14.1 (4.4); P = 0.03]. However, there was no significant association between bromocriptine use and the combined occurrence of all‐cause death and heart failure events (hazard ratio, 1.18; 95% confidence interval, 0.15 to 9.31), using univariable Cox regressions based over a cumulative follow‐up period of 285 patient‐years.ConclusionsIn women newly diagnosed with PPCM, treatment with bromocriptine was independently associated with greater LV functional recovery.

Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy

“…Both high and low doses were associated with low mortality (there was no placebo arm). A Canadian study reported a greater LV recovery in PPCM patients treated with bromocriptine . Treatment with bromocriptine may especially be considered in patients with right ventricular involvement .…”

The Effect of Bromocriptine on Clinical and Laboratory Parameters in Patients With Peripartum Cardiomyopathy

“…По мнению M. TremblayGravel и соавт., использова ние бромокриптина в начальном периоде болезни может ограничить степень повреждения, если во главу поста вить необходимость ингибирования пролактина [12].…”

The Canadian Women’s Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 5: Sex- and Gender-Unique Manifestations of Cardiovascular Disease

“… 123 A protein resulting from cleavage of the lactation hormone prolactin, 16-kilodalton, has anti-angiogenic properties, and has been linked to myocyte damage and HF in animal models. 124 Higher LV end diastolic diameter, low LVEF on presentation, and African American ethnicity have been associated with poor LV recovery. 125 In addition to standard HF goal-directed medical therapy, bromocriptine, an antagonist of prolactin production in the anterior hypothalamus, might be useful in improving LVEF and clinical outcomes at follow-up.…”

“…125 In addition to standard HF goal-directed medical therapy, bromocriptine, an antagonist of prolactin production in the anterior hypothalamus, might be useful in improving LVEF and clinical outcomes at follow-up. 121 , 124 Anticoagulation is recommended in conjunction with bromocriptine, and might be considered in women with PPCM and very low LVEF. 121 Pregnancy after a diagnosis of PPCM should be avoided in women with any residual LV impairment (LVEF ≤ 50%-55%).…”