The Medical Treatment of New Onset Peripartum Cardiomyopathy; a Systematic Review of prospective studies

Abstract

Background

Peripartum cardiomyopathy (PPCM) is a rare disorder with potentially fatal consequences, occurring mainly in previously healthy women. The etiology of PPCM remains unknown and various pathologic mechanisms have been proposed, including immune-mediated injuries and impaired response to oxidative stress and inflammatory cytokines. Several therapies have been studied, but few have been validated in a well-designed randomized controlled trial.

Methods

The present study sought to review the medical treatment intended for acute PPCM. To this end, we performed a systematic review of the literature of randomized and non-randomized prospective clinical studies.

Results

We identified two randomized controlled trials evaluating the dopamine agonist bromocriptine and the inotrope levosimendan, respectively, and one non-randomized study evaluating the non-selective phosphodiesterase inhibitor pentoxifylline. We reviewed the pathophysiological, pharmacological and clinical properties for each treatment option identified. Bromocriptine and pentoxifylline both improved left ventricular systolic function and patient-oriented clinical endpoints while levosimendan did not improve mortality or echocardiographic findings of PPCM.

Conclusions

This review identified bromocriptine and pentoxifylline, but not levosimendan, as potentially useful agents to improve left ventricle function and outcomes in PPCM.

Источник: www.onlinecjc.ca