Bromocriptine for peripartum cardiomyopathy improved LVEF recovery by 9-12% and reduced relative mortality by 35-45% compared to standard therapy, without increasing thromboembolic risk.
Does targeted prolactin blockade with bromocriptine improve LVEF recovery and reduce mortality in patients with peripartum cardiomyopathy compared to standard therapy alone?
Bromocriptine added to standard therapy significantly improves LVEF recovery and reduces mortality in peripartum cardiomyopathy without increasing thromboembolic risk when co-administered with prophylactic anticoagulation.
Absolute Event Rate: 0% vs 0%
ABSTRACT Peripartum cardiomyopathy (PPCM) remains a leading cause of maternal heart failure worldwide, yet its management has entered a transformative “bromocriptine era” with renewed mechanistic insight and emerging multicenter data. This systematic review and meta-analysis reappraises the pathobiology, therapeutic strategies, and patient selection criteria for targeted prolactin blockade in PPCM. Following PRISMA 2020 standards, a comprehensive search of PubMed, Embase, and Cochrane Library (last updated May 2025) identified 1,896 records, from which 35 studies met inclusion criteria encompassing randomized trials, registries, observational cohorts, and mechanistic investigations. Data were extracted independently by two reviewers using validated bias-assessment tools (AMSTAR-2, ROBINS-I/E, RoB-2, and SANRA). Outcomes included left ventricular ejection fraction (LVEF) recovery, mortality, and adverse events. Across pooled analyses, bromocriptine use was consistently associated with improved LVEF recovery (mean Δ +9–12%) and a 35–45% relative reduction in mortality compared with standard therapy alone, without increased thromboembolic risk when paired with prophylactic anticoagulation. Mechanistic studies confirmed suppression of the pathogenic 16-kDa prolactin fragment and oxidative injury. Subgroup findings highlighted the importance of early initiation (≤72 hours postpartum), therapy duration ≥6 weeks, and integrated lactation and thromboprophylaxis planning. The present synthesis provides the first unified evaluation of targeted prolactin blockade within contemporary cardio-obstetric care. Beyond validating bromocriptine’s efficacy and safety, it establishes a refined perinatal care pathway that integrates mechanistic rationale, maternal–fetal safety, and policy-level recommendations. These findings call for harmonized clinical protocols, expanded registries, and global equity in access to advanced PPCM therapy.
Efendi Lukas (Fri,) reported a other. Bromocriptine for peripartum cardiomyopathy improved LVEF recovery by 9-12% and reduced relative mortality by 35-45% compared to standard therapy, without increasing thromboembolic risk.
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