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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: A proof-of-concept pilot study
Circulation, Volume 121, No. 13, Year 2010
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Description
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. © 2010 American Heart Association, Inc.
Authors & Co-Authors
Sliwa, Karen S.
South Africa, Cape Town
Faculty of Health Sciences
South Africa, Johannesburg
University of the Witwatersrand
Blauwet, Lori A.
United States, Rochester
Mayo Clinic
Tibazarwa, Kemi B.
South Africa, Cape Town
Faculty of Health Sciences
South Africa, Johannesburg
University of the Witwatersrand
South Africa, Observatory
Groote Schuur Hospital
Libhaber, Elena N.
South Africa, Johannesburg
University of the Witwatersrand
Smedema, Jan Peter
South Africa, Sandton
Netcare
Becker, Anthony C.
South Africa, Johannesburg
University of the Witwatersrand
McMurray, John JV
United Kingdom, London
British Heart Foundation
Yamac, Hatice
Germany, Hannover
Hannover Medical School
Labidi, Saida
Germany, Hannover
Hannover Medical School
Struman, Ingrid
Belgium, Liege
Giga-r
Hilfiker-Kleiner, Denise
Germany, Hannover
Hannover Medical School
Statistics
Citations: 11
Authors: 11
Affiliations: 8
Identifiers
Doi:
10.1161/CIRCULATIONAHA.109.901496
ISSN:
00097322
e-ISSN:
15244539
Research Areas
Health System And Policy
Maternal And Child Health
Noncommunicable Diseases
Sexual And Reproductive Health
Study Design
Cohort Study
Participants Gender
Female