Cabergoline in the Treatment of Peripartum Cardiomyopathy

It is premature to make a recommendation for treatment of peripartum cardiomyopathy (PPCM) with prolactin inhibition (bromocriptine or cabergoline) as in the one-case report of Melo et al.[1]

There are now multiple reports of trials for PPCM subjects in the use prolactin inhibition treatment compared with non-use of this modality that show no statistically significant benefit in recovery outcomes at 6 and 12 months postpartum.[2] [3]

Furthermore, there is still potential risk to the use of these agents in the peripartum setting, with multiple reports of cardiovascular catastrophes, including myocardial infarction, coronary artery spasm, and stroke.[4]

What is still needed is a carefully controlled investigation of use of bromocriptine or cabergoline vs non-use as adjunct or non-adjunct to conventional therapy for heart failure with systolic dysfunction.

Melo et al emphasize the need for effective treatment of PPCM “[…]particularly in developing countries.” We have shown the devastating effect on otherwise healthy neonates whose mothers died from PPCM, with high mortality rates for these children as a consequence of losing the source of breast milk when a mother dies.[5] An effective program to provide alternative nutrition must accompany any treatment program that deprives newborns of a mother's breast milk. This is an issue of concern particularly in developing countries.

• References

• 1 Melo MA, Carvalho JS, Feitosa FE , et al. Peripartum cardiomyopathy treatment with dopamine agonist and subsequent pregnancy with a satisfactory outcome. Rev Bras Ginecol Obstet 2016; 38 (6) 308-313
• 2 Fett JD. Peripartum cardiomyopathy: challenges in diagnosis and management. Expert Rev Cardiovasc Ther 2016; 14 (9) 1035-1041 [Epub ahead of print]
• 3 McNamara DM, Elkayam U, Alharethi R , et al; IPAC Investigators. Clinical Outcomes for Peripartum Cardiomyopathy in North America: Results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy). J Am Coll Cardiol 2015; 66 (8) 905-914
• 4 Jeanneteau P, Bière L, Mercier MB, Descamps P, Sentilhes L. Bromocriptine-induced coronary spasm in postpartum. Eur J Obstet Gynecol Reprod Biol 2014; 179: 258-259
• 5 Fett JD, Murphy JG. Infant survival in Haiti after maternal death from peripartum cardiomyopathy. Int J Gynaecol Obstet 2006; 94 (2) 135-136

• References

• 1 Hilfiker-Kleiner D, Kaminski K, Podewski E , et al. A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell 2007; 128 (3) 589-600
• 2 Sliwa K, Blauwet L, Tibazarwa K , et al. Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study. Circulation 2010; 121 (13) 1465-1473
• 3 Hilfiker-Kleiner D, Meyer GP, Schieffer E , et al. Recovery from postpartum cardiomyopathy in 2 patients by blocking prolactin release with bromocriptine. J Am Coll Cardiol 2007; 50 (24) 2354-2355
• 4 Carlin AJ, Alfirevic Z, Gyte GM. Interventions for treating peripartum cardiomyopathy to improve outcomes for women and babies. Cochrane Database Syst Rev 2010; (9) CD008589
• 5 Elkayam U, Goland S. Bromocriptine for the treatment of peripartum cardiomyopathy. Circulation 2010; 121 (13) 1463-1464
• 6 Haghikia A, Podewski E, Berliner D , et al. Rationale and design of a randomized, controlled multicentre clinical trial to evaluate the effect of bromocriptine on left ventricular function in women with peripartum cardiomyopathy. Clin Res Cardiol 2015; 104 (11) 911-917
• 7 Johnson-Coyle L, Jensen L, Sobey A ; American College of Cardiology Foundation; American Heart Association. Peripartum cardiomyopathy: review and practice guidelines. Am J Crit Care 2012; 21 (2) 89-98
• 8 Fett JD, Murphy JG. Infant survival in Haiti after maternal death from peripartum cardiomyopathy. Int J Gynaecol Obstet 2006; 94 (2) 135-136