P14 Use of bromocriptine for the treatment of peripartum cardiomyopathy: a meta-analysis of randomized controlled trials (original) (raw)
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Revista brasileira de ginecologia e obstetrícia : revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2016
Pathophysiological mechanisms of peripartum cardiomyopathy are not yet completely defined, although there is a strong association with various factors that are already known, including pre-eclampsia. Peripartum cardiomyopathy treatment follows the same recommendations as heart failure with systolic dysfunction. Clinical and experimental studies suggest that products of prolactin degradation can induce this cardiomyopathy. The pharmacological suppression of prolactin production by D2 dopamine receptor agonists bromocriptine and cabergoline has demonstrated satisfactory results in the therapeutic response to the treatment. Here we present a case of an adolescent patient in her first gestation with peripartum cardiomyopathy that evolved to the normalized left ventricular function after cabergoline administration, which was used as an adjuvant in cardiac dysfunction treatment. Subsequently, despite a short interval between pregnancies, the patient exhibited satisfactory progress through...
ESC Heart Failure, 2018
Aims Bromocriptine 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 results Consecutive 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. Conclusions In women newly diagnosed with PPCM, treatment with bromocriptine was independently associated with greater LV functional recovery.
Evaluation of Bromocriptine in the Treatment of Acute Severe Peripartum Cardiomyopathy
Circulation, 2010
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 w...
Effectiveness of bromocriptine treatment in a patient with peripartum cardiomyopathy
Journal of Cardiology Cases, 2010
Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening disorder that occurs in late pregnancy or the early puerperium despite optimal medical therapy. Recently, oxidative stress-mediated generation of antiangiogenic and proapoptotic 16-kDa prolactin, and subsequent impaired cardiac microvascularization have been related to PPCM. In turn, prolactin blockade with bromocriptine has been proven successful in preventing the onset of PPCM in mice and in patients at high risk for the disease. Here, we report the efficacy of bromocriptine for treatment of a patient with PPCM.
Bromocriptine Use in Peripartum Cardiomyopathy: Review of Cases
American Journal of Perinatology Reports, 2018
Peripartum cardiomyopathy (PPCM) is a rare but potentially devastating form of cardiomyopathy occurring late in pregnancy or early postpartum period in previously healthy women. 1 Pregnancy associated heart failure was first described in the 1800s; however it was not until 1971 that Demakis and Rahimtoola who recognized the disease as a distinct entity and coined the term peripartum cardiomyopathy. 1-3 According to the 2010 European Society of Cardiology (ESC), diagnosis of PPCM is made by echocardiography demonstrating ejection fracture of < 45% with or without the left ventricular dilation with no evidence of other potential etiologies of heart failure. 4 Our goal is to provide brief overview of PPCM, review published cases of PPCM treated with bromocriptine and outline pros and cons of the treatment strategy.
European Journal of Heart Failure, 2010
Peripartum cardiomyopathy (PPCM) is a cause of pregnancy-associated heart failure. It typically develops during the last month of, and up to 6 months after, pregnancy in women without known cardiovascular disease. The present position statement offers a state-of-the-art summary of what is known about risk factors for potential pathophysiological mechanisms, clinical presentation of, and diagnosis and management of PPCM. A high index of suspicion is required for the diagnosis, as shortness of breath and ankle swelling are common in the peripartum period. Peripartum cardiomyopathy is a distinct form of cardiomyopathy, associated with a high morbidity and mortality, but also with the possibility of full recovery. Oxidative stress and the generation of a cardiotoxic subfragment of prolactin may play key roles in the pathophysiology of PPCM. In this regard, pharmacological blockade of prolactin offers the possibility of a disease-specific therapy.
Bromcriptine and cardiomyopathy
Cardiovascular diseases (CVD) are a major cause of complications in pregnancies worldwide, and can be largely attributed to increased cardiovascular risk factors, such as obesity and hypertensive disorders. 1 Today, up to 4 % of all pregnancies are complicated by CVD, with increasing frequency. 2 Cardiomyopathies -whether inherited or acquired -represent the leading cause of maternal morbidity and mortality in Western industrialised countries. 2 Among these, peripartum cardiomyopathy (PPCM) is particularly important because of notable foetal and maternal morbidity and a significant contribution to maternal deaths in previously healthy women. 3-5 Early diagnosis and immediate initiation of an appropriate therapy are crucial in improving the prognosis of this life-threatening disease in young women. 3,6-11
An update on treatments and outcomes in peripartum cardiomyopathy
Future cardiology, 2014
Peripartum cardiomyopathy (PPCM) is a well-established complication of pregnancy. Criteria include heart failure that presents with reduced left ventricular function, signs and symptoms of heart failure either late in pregnancy or early in the postpartum period. The incidence varies widely depending geography and ethnicity. The pathophysiology of PPCM is still an area of active investigation, but includes immune and inflammatory mechanisms, which are the subject of several investigations. Therapies for chronic heart failure from PPCM are similar to those patients with nonischemic cardiomyopathy from different etiologies, however novel therapies may include bromocriptine, pentoxifylline or other potential therapies influencing the immune system. The need for implantable defibrillators, left ventricular assist devices and cardiac transplant in women with PPCM is rare, and prognosis is better than other forms of nonischemic cardiomyopathy. Despite this, further information about the ep...