Bromocriptine plus standard therapy significantly increased LVEF recovery odds by 2.8 times (p=0.03) but showed a non-significant 39% mortality reduction (OR=0.61, p=0.16) in PPCM.
Does bromocriptine added to standard heart failure medication improve LVEF recovery and reduce mortality in patients with peripartum cardiomyopathy?
In patients with peripartum cardiomyopathy, adding bromocriptine to standard heart failure therapy significantly improves LVEF recovery but does not significantly reduce mortality.
Absolute Event Rate: 0% vs 0%
Abstract Background Peripartum cardiomyopathy (PPCM) is a rare but severe form of acute heart failure in the late stage of pregnancy and the first months postpartum. Antiangiogenic 16kDa prolactin seems to play a key role in the pathophysiology of PPCM, therefore prolactin-suppressing agents such as bromocriptine have been proposed in addition to standard heart failure medication for PPCM. Purpose Bromocriptine therapy remains part of current scientific discussions concerning its outcome for patients suffering from PPCM. As it requires weaning, it is associated with relevant changes in the postpartum phase for mother and child. The aim of our study was to provide an up-to-date overview of the efficacy of bromocriptine in relation to maternal mortality and LVEF recovery as important outcome predictors for PPCM. Methods We conducted a comprehensive literature search and two binary outcome meta-analyses with odds ratios (OR) as the effect measure. The inclusion criteria were (1) comparison of bromocriptine (experimental) versus standard heart failure therapy (control) in terms of mortality in PPCM or (2) analysis of LV recovery comparing bromocriptine against the control group in randomized trials or registers. Results We analysed the results of seven studies that evaluated the effect on mortality and six studies that evaluated LV recovery since the establishment of bromocriptine therapy in 2010 (1-9). Two of the included studies were randomised controlled trials (1,7), while the rest were cohort studies. In total we included 1,213 patients. The probability of LVEF recovery with bromocriptine therapy was significantly higher than with standard medication alone (OR =2.8, p = 0.03). With regard to mortality, there was a trend towards lower mortality under treatment with bromocriptine (OR= 0.61), though the difference did not reach statistical significance (p= 0.16). All-cause mortality showed no heterogeneity, while improvement in LVEF displayed low to medium study heterogeneity. Conclusion In our meta-analysis, bromocriptine in addition to standard heart failure medication was associated with a significantly better recovery of LVEF. This supports the current guideline recommendation to add bromocriptine in severe PPCM. Nevertheless, no significant benefit in terms of mortality could be demonstrated. However, in view of the vulnerable patient group of young mothers, a mortality reduction of 39% is relevant. Our study results support the hypothesis that the use of bromocriptine in the treatment of PPCM could be further individualised to optimise patient benefit from the therapy.All-cause mortality LV recovery
Lueg et al. (Sat,) reported a other. Bromocriptine plus standard therapy significantly increased LVEF recovery odds by 2.8 times (p=0.03) but showed a non-significant 39% mortality reduction (OR=0.61, p=0.16) in PPCM.