Key result
Bromocriptine added to standard therapy normalizes diastolic function, lowering E/E' from ~16 to 8.
Why the study?
Does adding bromocriptine to standard heart failure therapy improve left ventricular diastolic dysfunction in a patient with peripartum cardiomyopathy?
Case Report (n=1)
No
Does adding bromocriptine to standard heart failure therapy improve left ventricular diastolic dysfunction in a patient with peripartum cardiomyopathy?
This case report provides initial clinical observation that bromocriptine may promote early recovery of severe LV diastolic dysfunction and diastolic dyssynchrony, detectable by Tissue Doppler imaging, even prior to full systolic recovery in peripartum cardiomyopathy.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for bromocriptine in peripartum cardiomyopathy diastolic dysfunction; prospective trials needed before adoption.
Management of patients with peripartum cardiomyopathy (PPCM) is still a major clinical problem, as only half of them or slightly more show complete recovery of left ventricular (LV) function despite conventional evidence-based treatment for heart failure. Recent observations suggested that bromocriptine might favor recovery of LV systolic function in patients with PPCM. However, no evidence exists regarding its effect on LV diastolic dysfunction, which is commonly observed in these patients. Tissue Doppler (TD) is an echocardiographic technique that provides unique information on LV diastolic performance. We report the case of a 37-year-old white woman with heart failure (NYHA class II), moderate LV systolic dysfunction (ejection fraction 35%), and severe LV diastolic dysfunction secondary to PPCM, who showed no improvement after 2 weeks of treatment with ramipril, bisoprolol, and furosemide. At 6-week followup after addition of bromocriptine, despite persistence of LV systolic dysfunction, normalization of LV diastolic function was shown by TD, together with improvement in functional status (NYHA I). At 18-month followup, the improvement in LV diastolic function was maintained, and normalization of systolic function was observed. This paper might support the clinical utility of bromocriptine in patients with PPCM by suggesting a potential benefit on LV diastolic dysfunction.
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Ballo et al. (2012) conducted a case report in Peripartum cardiomyopathy (PPCM) with severe left ventricular diastolic dysfunction and moderate systolic dysfunction (n=1). Bromocriptine was evaluated on Left ventricular diastolic function assessed by Tissue Doppler (E/E' ratio and E' velocity) and LV systolic function (LVEF). Bromocriptine added to standard therapy normalized LV diastolic function and improved functional class from II to I at 6 weeks, with LVEF normalizing to 60% at 18 months.
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