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Effects of bromocriptine in peripartum cardiomyopathy: a systematic review and meta-analysis

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Abstract

Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening form of heart failure (HF). Bromocriptine, a dopamine D2 agonist, has been used as an adjunctive treatment for PPCM with controversial benefits. A comprehensive literature search was conducted through June 2021. We included studies comparing the outcomes of PPCM with or without bromocriptine use. Pooled risk ratio (RR) with 95% confidence intervals (CI) and I2 statistics were calculated. Composite major adverse outcomes were defined by a composite of death, need for advanced HF therapies, persistent New York Heart Association (NYHA) functional class III/V, or left ventricular ejection fraction (LVEF) ≤ 35% at 6-month follow-up. LVEF recovery was defined by improvement of LVEF to more than 50%. Eight studies (two randomized-controlled, six observational) involving 593 PPCM patients were included. Bromocriptine use was associated with significantly higher survival (91.6% vs. 83.9%, RR 1.11 p = 0.02). Baseline LVEF was not significantly different between the groups. LVEF at follow-up was significantly higher in the bromocriptine group (53.3% vs. 41.8%, p < 0.001). There was no significant association between bromocriptine use and lower composite major adverse outcomes (13.7% vs. 33.3%, RR 0.60 p = 0.54) or LVEF recovery (46.9% vs. 46.8%, RR 0.94 p = 0.74). In conclusion, the addition of bromocriptine to standard HF treatment in PPCM was associated with significantly higher survival and higher LVEF improvement. No association with lower composite adverse clinical outcomes or LVEF recovery was seen. The findings, although encouraging, warrant larger randomized-controlled studies.

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Abbreviations

CI:

Confidence interval

DCM:

Dilated cardiomyopathy

ESC:

European Society of Cardiology

HF:

Heart failure

NYHA:

New York Heart Association

LVEF:

Left ventricular ejection fraction

PPCM:

Peripartum cardiomyopathy

RCT:

Randomized-controlled trial

RR:

Risk ratio

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Medicine, AMITA Health Saint Francis Hospital, IL, Evanston, USA

    Angkawipa Trongtorsak

  2. Division of Cardiology, Duke University Medical Center, Durham, NC, USA

    Veraprapas Kittipibul

  3. Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA, USA

    Sunita Mahabir

  4. Section of Cardiology, Temple University, Philadelphia, PA, USA

    Michel Ibrahim

  5. Division of Cardiology, Columbia University at Mount Sinai Medical Center, Miami Beach, FL, USA

    Garly R. Saint Croix

  6. Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA

    Gabriel A. Hernandez

  7. Advanced Heart Failure Program, Baptist Health South Florida, Miami, FL, USA

    Sandra Chaparro

Authors
  1. Angkawipa Trongtorsak
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  2. Veraprapas Kittipibul
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  3. Sunita Mahabir
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  4. Michel Ibrahim
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  5. Garly R. Saint Croix
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  6. Gabriel A. Hernandez
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  7. Sandra Chaparro
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Contributions

All authors have approved this present manuscript for submission. AT: data acquisition and manuscript preparation VK: conception and design, data acquisition, and manuscript preparation SM: data acquisition and manuscript preparation MI: analysis and interpretation of the data. GRSC: analysis and interpretation of the data GAH: validation and manuscript editing. SC: supervision and manuscript editing.

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Correspondence to Angkawipa Trongtorsak.

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Trongtorsak, A., Kittipibul, V., Mahabir, S. et al. Effects of bromocriptine in peripartum cardiomyopathy: a systematic review and meta-analysis. Heart Fail Rev 27, 533–543 (2022). https://doi.org/10.1007/s10741-021-10185-8

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  • DOI: https://doi.org/10.1007/s10741-021-10185-8

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