Efficacy and safety of bromocriptine in peripartum cardiomyopathy: A systematic review and meta-analysis.

BACKGROUND

Peripartum cardiomyopathy (PPCM) is a rare but potentially serious pregnancy complication. The use of bromocriptine in addition to standard treatment has been recommended; however, the evidence supporting its efficacy remains limited.

METHODS

A systematic search was conducted across 4 databases including PubMed, Embase, Web of Science, and Cochrane CENTRAL, from inception to September 13, 2024, without language restrictions. The inclusion criteria were studies that compared the efficacy of bromocriptine in addition to standard treatment versus standard treatment alone in PPCM patients and reported outcomes on LVEF, LV function recovery, all-cause mortality, rehospitalization, New York Heart Association (NYHA) class III/IV, major adverse cardiac events (MACE), and thromboembolism.

RESULTS

There were 11 studies included in this meta-analysis, involving 1706 participants. Bromocriptine was associated with a greater ΔLVEF (Post-Pretreatment LVEF) compared to the control group, with a mean difference (MD) of 10.03 % (95 %CI 3.88 % to 16.17 %), p < 0.01. Subgroup analysis demonstrated that bromocriptine was associated with increased ΔLVEF compared to the control group only in the subgroup with baseline LVEF<30. Bromocriptine was associated with a significantly higher post-treatment LVEF compared to standard treatment alone, with an MD of 8.50 % (95 %CI 3.39 % to 13.61 %), p < 0.01. Additionally, subgroup analysis showed that bromocriptine was associated with higher post-treatment LVEF regardless of study design and baseline LVEF. There was no significant difference in LV function recovery, all-cause mortality, rehospitalization, NYHA class III/IV, MACE, and thromboembolism.

CONCLUSIONS

Bromocriptine is associated with greater ΔLVEF improvement and higher post-treatment LVEF compared to standard treatment alone in PPCM.