Ontology type: schema:ScholarlyArticle Open Access: True
2019-03
AUTHORSArash Haghikia, Johannes Schwab, Jens Vogel-Claussen, Dominik Berliner, Tobias Pfeffer, Tobias König, Carolin Zwadlo, Valeska Abou Moulig, Annegret Franke, Marziel Schwarzkopf, Philipp Ehlermann, Roman Pfister, Guido Michels, Ralf Westenfeld, Verena Stangl, Uwe Kühl, Edith Podewski, Ingrid Kindermann, Michael Böhm, Karen Sliwa, Denise Hilfiker-Kleiner, Johann Bauersachs
ABSTRACTBACKGROUND: Right ventricular (RV) dysfunction predicts adverse outcome in peripartum cardiomyopathy (PPCM). We recently demonstrated beneficial effects associated with the prolactin release inhibitor bromocriptine at different doses when added to standard heart failure therapy in PPCM. Here, we evaluated for the first time the therapeutic potential of bromocriptine particularly in PPCM patients with RV involvement. METHODS: In this study, 40 patients with PPCM were included, of whom 24 patients had reduced RV ejection fraction (RVEF < 45%). We examined the effect of short-term (1W: bromocriptine, 2.5 mg, 7 days, n = 10) compared with long-term bromocriptine treatment (8W: 5 mg for 2 weeks followed by 2.5 mg for another 6 weeks, n = 14) in addition to guideline-based heart failure therapy in patients with an initial RVEF < 45% on the following outcomes: (1) change from baseline (Δ delta) in RVEF, (2) change from baseline in left ventricular EF (LVEF), and (3) rate of patients with full LV recovery (LVEF ≥ 50%) and (4) rate of patients with full RV recovery (RVEF ≥ 55%) at 6-month follow-up as assessed by cardiac magnetic resonance imaging. RESULTS: Reduced RVEF at initial presentation was associated with a lower rate of full cardiac recovery at 6-month follow-up (patients with RV dysfunction: 58% vs. patients with normal RV function: 81%; p = 0.027). RVEF increased from 38 ± 7 to 53 ± 11% with a delta-RVEF of + 15 ± 12% in the 1W group, and from 35 ± 9 to 58 ± 7% with a Δ RVEF of + 23 ± 10% in the 8W group (Δ RVEF 1W vs 8W: p = 0.118). LVEF increased from 25 ± 8 to 46 ± 12% with a Δ LVEF of + 21 ± 11% in the 1W group, and from 22 ± 6 to 49 ± 10% with a Δ LVEF of + 27 ± 9% in the 8W group (Δ LVEF 1W vs 8W: p = 0.211). Full LV recovery was present in 50% of the 1W group and in 64% of the 8W group (p = 0.678). Full RV recovery was observed in 40% of the 1W group and in 79% of the 8W group (p = 0.092). CONCLUSIONS: Despite overall worse outcome in patients with RV dysfunction at baseline, bromocriptine treatment in PPCM patients with RV involvement was associated with a high rate of full RV and LV recovery, although no significant differences were observed between the short-term and long-term bromocriptine treatment regime. These findings suggest that bromocriptine in addition to standard heart failure therapy may be also effective in PPCM patients with biventricular impairment. More... »
PAGES290-297
http://scigraph.springernature.com/pub.10.1007/s00392-018-1355-7
DOIhttp://dx.doi.org/10.1007/s00392-018-1355-7
DIMENSIONShttps://app.dimensions.ai/details/publication/pub.1106224684
PUBMEDhttps://www.ncbi.nlm.nih.gov/pubmed/30121697
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"description": "BACKGROUND: Right ventricular (RV) dysfunction predicts adverse outcome in peripartum cardiomyopathy (PPCM). We recently demonstrated beneficial effects associated with the prolactin release inhibitor bromocriptine at different doses when added to standard heart failure therapy in PPCM. Here, we evaluated for the first time the therapeutic potential of bromocriptine particularly in PPCM patients with RV involvement.\nMETHODS: In this study, 40 patients with PPCM were included, of whom 24 patients had reduced RV ejection fraction (RVEF\u2009<\u200945%). We examined the effect of short-term (1W: bromocriptine, 2.5\u00a0mg, 7\u00a0days, n\u2009=\u200910) compared with long-term bromocriptine treatment (8W: 5\u00a0mg for 2\u00a0weeks followed by 2.5\u00a0mg for another 6\u00a0weeks, n\u2009=\u200914) in addition to guideline-based heart failure therapy in patients with an initial RVEF\u2009<\u200945% on the following outcomes: (1) change from baseline (\u0394 delta) in RVEF, (2) change from baseline in left ventricular EF (LVEF), and (3) rate of patients with full LV recovery (LVEF\u2009\u2265\u200950%) and (4) rate of patients with full RV recovery (RVEF\u2009\u2265\u200955%) at 6-month follow-up as assessed by cardiac magnetic resonance imaging.\nRESULTS: Reduced RVEF at initial presentation was associated with a lower rate of full cardiac recovery at 6-month follow-up (patients with RV dysfunction: 58% vs. patients with normal RV function: 81%; p\u2009=\u20090.027). RVEF increased from 38\u2009\u00b1\u20097 to 53\u2009\u00b1\u200911% with a delta-RVEF of +\u200915\u2009\u00b1\u200912% in the 1W group, and from 35\u2009\u00b1\u20099 to 58\u2009\u00b1\u20097% with a \u0394 RVEF of +\u200923\u2009\u00b1\u200910% in the 8W group (\u0394 RVEF 1W vs 8W: p\u2009=\u20090.118). LVEF increased from 25\u2009\u00b1\u20098 to 46\u2009\u00b1\u200912% with a \u0394 LVEF of +\u200921\u2009\u00b1\u200911% in the 1W group, and from 22\u2009\u00b1\u20096 to 49\u2009\u00b1\u200910% with a \u0394 LVEF of +\u200927\u2009\u00b1\u20099% in the 8W group (\u0394 LVEF 1W vs 8W: p\u2009=\u20090.211). Full LV recovery was present in 50% of the 1W group and in 64% of the 8W group (p\u2009=\u20090.678). Full RV recovery was observed in 40% of the 1W group and in 79% of the 8W group (p\u2009=\u20090.092).\nCONCLUSIONS: Despite overall worse outcome in patients with RV dysfunction at baseline, bromocriptine treatment in PPCM patients with RV involvement was associated with a high rate of full RV and LV recovery, although no significant differences were observed between the short-term and long-term bromocriptine treatment regime. These findings suggest that bromocriptine in addition to standard heart failure therapy may be also effective in PPCM patients with biventricular impairment.",
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"name": "Clinical Research in Cardiology",
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"name": "Bromocriptine treatment in patients with peripartum cardiomyopathy and right ventricular dysfunction",
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