Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study. (original) (raw)
Article (Scientific journals)
Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study.
; Blauwet, Lori; Tibazarwa, Kemi et al.
2010 • In Circulation, 121 (13), p. 1465-73
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Keywords :
Acute Disease; Adolescent; Adult; Blood Pressure/drug effects; Bromocriptine/administration & dosage; Cardiomyopathies/drug therapy/ultrasonography; Cathepsin D/blood; Female; Heart Failure/drug therapy/ultrasonography; Hormone Antagonists/administration & dosage; Humans; Infant, Newborn; Middle Aged; Parturition; Pilot Projects; Pregnancy; Pregnancy Complications, Cardiovascular/drug therapy/ultrasonography; Pregnancy Outcome; Prolactin/blood; Thromboembolism/diagnosis; Treatment Outcome; Ventricular Function, Left/drug effects; Young Adult
Abstract :
[en] BACKGROUND: Peripartum cardiomyopathy (PPCM) is a potentially life-threatening heart disease that occurs in previously healthy women. We identified prolactin, mainly its 16-kDa angiostatic and proapoptotic form, as a key factor in PPCM pathophysiology. Previous reports suggest that bromocriptine may have beneficial effects in women with acute onset of PPCM. METHODS AND RESULTS: A prospective, single-center, randomized, open-label, proof-of-concept pilot study of women with newly diagnosed PPCM receiving standard care (PPCM-Std; n=10) versus standard care plus bromocriptine for 8 weeks (PPCM-Br, n=10) was conducted. Because mothers receiving bromocriptine could not breast-feed, the 6-month outcome of their children (n=21) was studied as a secondary end point. Blinded clinical, hemodynamic, and echocardiographic assessments were performed at baseline and 6 months after diagnosis. Cardiac magnetic resonance imaging was performed 4 to 6 weeks after diagnosis in PPCM-Br patients. There were no significant differences in baseline characteristics, including serum 16-kDa prolactin levels and cathepsin D activity, between the 2 study groups. PPCM-Br patients displayed greater recovery of left ventricular ejection fraction (27% to 58%; P=0.012) compared with PPCM-Std patients (27% to 36%) at 6 months. One patient in the PPCM-Br group died compared with 4 patients in the PPCM-Std group. Significantly fewer PPCM-Br patients (n=1, 10%) experienced the composite end point of poor outcome defined as death, New York Heart Association functional class III/IV, or left ventricular ejection fraction <35% at 6 months compared with the PPCM-Std patients (n=8, 80%; P=0.006). Cardiac magnetic resonance imaging revealed no intracavitary thrombi. Infants of mothers in both groups showed normal growth and survival. CONCLUSIONS: In this trial, the addition of bromocriptine to standard heart failure therapy appeared to improve left ventricular ejection fraction and a composite clinical outcome in women with acute severe PPCM, although the number of patients studied was small and the results cannot be considered definitive. Larger-scale multicenter and blinded studies are in progress to test this strategy more robustly.
Disciplines :
Biochemistry, biophysics & molecular biology
Author, co-author :
Sliwa, Karen
Blauwet, Lori
Tibazarwa, Kemi
Libhaber, Elena
Smedema, Jan*-Peter
Becker, Anthony
McMurray, John
Yamac, Hatice
Labidi, Saida
Struman, Ingrid ; Université de Liège - ULiège > Département des sciences de la vie > GIGA-R : Biologie et génétique moléculaire
Hilfiker-Kleiner, Denise
Title :
Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study.
Journal title :
Circulation
Publisher :
Lippincott Williams & Wilkins, Hagerstown, United States - Maryland
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 28 October 2010
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