溴隐亭治疗与围产期心肌病的结局：EORP PPCM注册研究
Bromocriptine treatment and outcomes in peripartum cardiomyopathy: the EORP PPCM registry.
作者信息
van der Meer Peter, van Essen Bart Johan, Viljoen Charle, Böhm Michael, Jackson Alice, Hilfiker-Kleiner Denise, Hoevelmann Julian, Mebazaa Alexandre, Farhan Hasan Ali, Goland Sorel, Ouwerkerk Wouter, Petrie Mark C, Seferović Petar M, Tromp Jasper, Sliwa Karen, Bauersachs Johann
机构信息
Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
出版信息
Eur Heart J. 2025 Mar 13;46(11):1017-1027. doi: 10.1093/eurheartj/ehae559.
BACKGROUND AND AIMS
Peripartum cardiomyopathy (PPCM) remains a serious threat to maternal health around the world. While bromocriptine, in addition to standard treatment for heart failure, presents a promising pathophysiology-based disease-specific treatment option in PPCM, the evidence regarding its efficacy remains limited. This study aimed to determine whether bromocriptine treatment is associated with improved maternal outcomes in PPCM.
METHODS
Peripartum cardiomyopathy patients from the EORP PPCM registry with available follow-up were included. The main exposure of this exploratory non-randomized analysis was bromocriptine treatment, and the main outcome was a composite endpoint of maternal outcome [death or hospital readmission within the first 6 months after diagnosis, or persistent severe left ventricular dysfunction (left ventricular ejection fraction < 35%) at 6-month follow-up]. Inverse probability weighting was used to minimize the effects of confounding by indication. Multiple imputation was used to account for the missing data.
RESULTS
Among the 552 patients with PPCM, 85 were treated with bromocriptine (15%). The primary endpoint was available in 491 patients (89%) and occurred in 18 out of 82 patients treated with bromocriptine in addition to standard of care (22%) and in 136 out of 409 patients treated with standard of care (33%) (P = .044). In complete case analysis, bromocriptine treatment was associated with reduced adverse maternal outcome [odds ratio (OR) 0.29, 95% confidence interval (CI) 0.10-0.83, P = .021]. This association remained after applying multiple imputation and methods to correct for confounding by indication (inverse probability weighted model on imputed data: OR 0.47, 95% CI 0.31-0.70, P < 0.001). Thromboembolic events were observed in 6.0% of the patients in the bromocriptine group vs. 5.6% in the standard of care group (P = .900).
CONCLUSIONS
Among women with PPCM, bromocriptine treatment in addition to standard of care was associated with better maternal outcomes after 6 months.
背景与目的
围产期心肌病（PPCM）仍然是全球范围内对孕产妇健康的严重威胁。虽然除心力衰竭的标准治疗外，溴隐亭在PPCM中提供了一种基于病理生理学的、有前景的疾病特异性治疗选择，但其疗效的证据仍然有限。本研究旨在确定溴隐亭治疗是否与PPCM患者更好的孕产妇结局相关。
方法
纳入来自EORP PPCM登记处且有可用随访数据的围产期心肌病患者。这项探索性非随机分析的主要暴露因素是溴隐亭治疗，主要结局是孕产妇结局的复合终点[诊断后前6个月内死亡或再次入院，或6个月随访时持续存在严重左心室功能障碍（左心室射血分数<35%）]。采用逆概率加权法以尽量减少指征性混杂因素的影响。使用多重填补法处理缺失数据。
结果
在552例PPCM患者中，85例接受了溴隐亭治疗（15%）。491例患者（89%）有主要终点数据，在82例除标准治疗外还接受溴隐亭治疗的患者中有18例（22%）发生主要终点事件，在409例接受标准治疗的患者中有136例（33%）发生主要终点事件（P = 0.044）。在完整病例分析中，溴隐亭治疗与不良孕产妇结局减少相关[比值比（OR）0.29，95%置信区间（CI）0.10 - 0.83，P = 0.021]。在应用多重填补法和校正指征性混杂因素的方法后，这种关联仍然存在（对填补数据的逆概率加权模型：OR 0.47，95% CI 补0.31 - 0.70，P < 0.疗001）。溴隐亭组6.0%的患者发生血栓栓塞事件，标准治疗组为5.6%（P = 0.900）。
结论
在患有PPCM的女性中，除标准治疗外使用溴隐亭治疗与6个月后更好的孕产妇结局相关。
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