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The following is a summary of “Efficacy and safety of bromocriptine in peripartum cardiomyopathy: A systematic review and meta-analysis,” published in the March 2025 issue of the International Journal of Cardiology by Attachaipanich et al.

Peripartum cardiomyopathy (PPCM) is a rare yet potentially life-threatening condition that affects women during late pregnancy or the postpartum period, often leading to heart failure with reduced left ventricular ejection fraction (LVEF). While standard heart failure therapies remain the cornerstone of treatment, bromocriptine—a prolactin secretion inhibitor—has been proposed as an adjunctive therapy to improve cardiac recovery. However, the evidence supporting its efficacy remains limited and controversial. This meta-analysis aimed to systematically evaluate the impact of bromocriptine in addition to standard treatment on cardiac function and clinical outcomes in patients with PPCM. 

Eligible studies were those comparing bromocriptine plus standard treatment versus standard treatment alone in patients with PPCM, with reported outcomes on LVEF improvement (ΔLVEF), post-treatment LVEF, left ventricular (LV) function recovery, all-cause mortality, rehospitalization, New York Heart Association (NYHA) class III/IV status, major adverse cardiac events (MACE), and thromboembolic complications. A total of 11 studies involving 1,706 participants met the inclusion criteria. The analysis demonstrated that bromocriptine was significantly associated with a greater ΔLVEF (post-treatment minus pre-treatment LVEF) compared to standard treatment alone, with a mean difference of 10.03% (95% [CI]: 3.88% to 16.17%, P < 0.01). Subgroup analysis indicated that this benefit was particularly evident in patients with a baseline LVEF <30%. 

Additionally, bromocriptine use resulted in 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), an effect that remained consistent across different study designs and baseline LVEF levels. However, no significant differences were observed between the bromocriptine and control groups in terms of LV function recovery, all-cause mortality, rehospitalization rates, NYHA class III/IV persistence, MACE, or thromboembolic events. These findings suggest that bromocriptine may offer a meaningful benefit in improving LVEF in patients with PPCM, particularly those with severe LV dysfunction at baseline. However, the absence of significant effects on mortality and major clinical endpoints underscores the need for further large-scale, randomized trials with extended follow-up to better define the role of bromocriptine in PPCM management. Given the potential risks associated with bromocriptine, including thromboembolic complications, its use should be carefully considered on an individual basis, balancing potential benefits in LVEF recovery with safety concerns.

Source: internationaljournalofcardiology.com/article/S0167-5273(25)00148-2/abstract