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. 2023;19(2):e230822207933.
doi: 10.2174/1573403X18666220823151854.

Review of Randomized Controlled Trials in Patients with Peripartum Cardiomyopathy

Jasmin Mujkanovic  1 , Abbas Ali Qayyum  2
Affiliations

Review of Randomized Controlled Trials in Patients with Peripartum Cardiomyopathy

Jasmin Mujkanovic et al. Curr Cardiol Rev. 2023.

Abstract

Introduction: Peripartum cardiomyopathy (PPCM) is a rare but potentially lifethreatening disease, defined as idiopathic cardiomyopathy occurring towards the end of pregnancy or in the months following delivery, abortion or miscarriage. We aim to raise awareness of this condition and give an overview of current knowledge as well as an insight and comparison of clinical trials focusing on randomized controlled trials.

Material and methods: Systematic literature searches were conducted using PubMed up to December 2021. Studies published involving clinical trials and interventions in women with PPCM after 1970 were selected.

Results: Randomized controlled trials have shown that the addition of Bromocriptine to standardized heart failure therapy improves outcome in terms of recovery of Left Ventricular Ejection Fraction (LVEF), symptoms and death. Bromocriptine 2.5 mg twice daily for two weeks followed by 2.5 mg once daily for six weeks had the best trend and outcome. The addition of Levosimendan to standardized heart failure therapy had no effect, whereas the addition of Selenium improved heart failure symptoms but did not reduce risk in terms of unrecovered LVEF or death. One prospective study showed potential usage of TNF-alfa inhibitors, but was never tried in a randomized clinical trial.

Conclusion: PPCM is a rare and potentially fatal disease. New insights on pathophysiology, genetics and clinical studies, particularly randomized controlled trials, have shown that the addition of Bromocriptine has a beneficial effect in terms of improved LVEF and death. However, some clinical studies have shown promising results using anti-inflammatory pharmacological agents with an improvement in LVEF. We suggest that targeting an anti-inflammatory route may prove beneficial in patients with PPCM. However, further research is highly warranted.

Keywords: Heart failure; fatal disease; patients; peripartum cardiomyopathy; pregnancy; treatment of peripartum cardiomyopathy.

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Conflict of interest statement

The author(s) declare no conflict of interest, financial or otherwise.

Figures

Fig. (1)
Fig. (1)
Overview of selection and exclusion of studies.
Fig. (2)
Fig. (2)
Pathophysiology and pharmacological intervention.
Fig. (3)
Fig. (3)
Transthoracic echocardiograpy of patient with PPCM (LVEF 10-15%).
See this image and copyright information in PMC

References

    1. Sliwa K., Hilfiker D., Petrie M.C., et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: A position statement from the heart failure association of the european society of cardiology working group on peripartum cardiomyopathy. Eur. J. Heart Fail. 2010;12(8):767–778. doi: 10.1093/eurjhf/hfq120. - DOI - PubMed
    1. Bauersachs J., König T., van der Meer P., et al. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: A position statement from the heart failure association of the European society of cardiology study group on peripartum cardiomyopathy. Eur. J. Heart Fail. 2019;21(7):827–843. doi: 10.1002/ejhf.1493. - DOI - PubMed
    1. Pearson G.D., Veille J.C., Rahimtoola S., et al. Peripartum cardiomyopathy: National heart, lung, and blood institute and office of rare diseases (National Institutes of Health) workshop recommendations and review. JAMA. 2000;283(9):1183–1188. doi: 10.1001/jama.283.9.1183. - DOI - PubMed
    1. Elkayam U., Akhter M.W., Singh H., et al. Pregnancy associated cardiomyopathy: Clinical characteristics and a comparison between early and late presentation. Circulation. 2005;111(16):2050–2055. doi: 10.1161/01.CIR.0000162478.36652.7E. - DOI - PubMed
    1. Pillarisetti J., Kondur A., Alani A., et al. Peripartum cardiomyopathy: Predictors of recovery and current state of implantable cardioverter defibrillator use. J. Am. Coll. Cardiol. 2014;63(25 Pt A):2831–2839. doi: 10.1016/j.jacc.2014.04.014. - DOI - PubMed