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

射血分数 医学 围产期心肌病 不利影响 内科学 溴隐亭 置信区间 心肌病 心脏病学 相对风险 心力衰竭 激素 催乳素
作者
Angkawipa Trongtorsak,Veraprapas Kittipibul,Sunita Mahabir,Michel Ibrahim,Garly Rushler Saint Croix,Gabriel A. Hernandez,Sandra Chaparro
出处
期刊:Heart Failure Reviews [Springer Science+Business Media]
卷期号:27 (2): 533-543 被引量:17
标识
DOI:10.1007/s10741-021-10185-8
摘要

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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