Effects of Bromocriptine in Peripartum Cardiomyopathy: A Systematic Review and Meta-analysis

Background Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening form of heart failure affecting women toward the end trimester of pregnancy, during delivery, or early postpartum period. Bromocriptine, a dopamine D2 agonist, has been used as an adjunctive treatment for PPCM with controversial benefits. Methods : A comprehensive literature search was conducted through April 2020 using MEDLINE, EMBASE and Scopus. We included studies comparing outcomes of PPCM with or without bromocriptine use. Pooled risk ratio (RR) with 95% confidence intervals (CI) and I2 statistic were calculated using the random-effects model. Complete recovery was defined by improvement of left ventricular ejection fraction (LVEF) to more than 50%. Poor outcomes were defined by a composite of death, need for heart transplant or left ventricular assist device, persistent New York Heart Association (NYHA) functional class III/V or LVEF ≤ 35% at 6-month follow-up. Results We included 8 studies (2 randomized-controlled, 6 observational) involving 593 PPCM patients: 263 (44%) received bromocriptine. Baseline LVEF was not significantly different between 2 groups: 29.5% in bromocriptine group and 31.8% in control group. LVEF increased in both groups but LVEF at follow-up was significantly higher in the bromocriptine group: 53.3% vs. 41.8% with mean difference of 11.9% (95%CI 5.5-18.4, p Conclusions Our meta-analysis suggests that addition of bromocriptine to standard HF treatment in PPCM population was associated with significantly higher LVEF improvement and higher survival. No association with complete recovery (LVEF >50%) or lower composite adverse clinical outcomes (death, need for heart transplant or left ventricular assist device, persistent NYHA functional class III/V or LVEF ≤ 35%) was seen. The findings, although encouraging, should be studied in larger randomized-controlled studies.