Background and Aims Peripartum cardiomyopathy (PPCM) remains a serious threat to maternal health around the world. While bromocriptine, in addition to standard treatment for heart failure, presents a promising pathophysiology-based disease-specific treatment option in PPCM, the evidence regarding its efficacy remains limited. This study aimed to determine whether bromocriptine treatment is associated with improved maternal outcomes in PPCM. Methods Peripartum cardiomyopathy patients from the EORP PPCM registry with available follow-up were included. The main exposure of this exploratory non-randomized analysis was bromocriptine treatment, and the main outcome was a composite endpoint of maternal outcome [death or hospital readmission within the first 6 months after diagnosis, or persistent severe left ventricular dysfunction (left ventricular ejection fraction < 35%) at 6-month follow-up]. Inverse probability weighting was used to minimize the effects of confounding by indication. Multiple imputation was used to account for the missing data. Results Among the 552 patients with PPCM, 85 were treated with bromocriptine (15%). The primary endpoint was available in 491 patients (89%) and occurred in 18 out of 82 patients treated with bromocriptine in addition to standard of care (22%) and in 136 out of 409 patients treated with standard of care (33%) (P = .044). In complete case analysis, bromocriptine treatment was associated with reduced adverse maternal outcome [odds ratio (OR) 0.29, 95% confidence interval (CI) 0.10–0.83, P = .021]. This association remained after applying multiple imputation and methods to correct for confounding by indication (inverse probability weighted model on imputed data: OR 0.47, 95% CI 0.31-0.70, P < 0.001). Thromboembolic events were observed in 6.0% of the patients in the bromocriptine group vs. 5.6% in the standard of care group (P = .900). Conclusions Among women with PPCM, bromocriptine treatment in addition to standard of care was associated with better maternal outcomes after 6 months.

中文翻译：

---

溴隐亭治疗和围产期心肌病的结局： EORP PPCM 登记


背景和目标围产期心肌病 （PPCM） 仍然是世界各地孕产妇健康的严重威胁。虽然溴隐亭除了心力衰竭的标准治疗外，在 PPCM 中提供了一种有前途的基于病理生理学的疾病特异性治疗选择，但关于其疗效的证据仍然有限。本研究旨在确定溴隐亭治疗是否与 PPCM 孕产妇结局的改善有关。方法 纳入来自 EORP PPCM 登记处且可随访的围产期心肌病患者。这项探索性非随机分析的主要暴露是溴隐亭治疗，主要结局是孕产妇结局的复合终点 [诊断后前 6 个月内死亡或再入院，或持续严重的左心室功能障碍 （左心室射血分数 < 35%）在 6 个月的随访中]。使用逆概率加权来最小化适应症混杂的影响。多重插补用于解释缺失数据。结果 552 例 PPCM 患者中，85 例接受溴隐亭治疗 （15%）。主要终点在 491 名患者 （89%） 中可用，并且在 82 名接受溴隐亭治疗和标准治疗的患者中有 18 名 （22%） 和接受标准治疗治疗的 409 名患者中有 136 名 （33%） 发生 （P = .044）。在完整的病例分析中，溴隐亭治疗与不良孕产妇结局降低相关 [比值比 （OR） 0.29,95% 置信区间 （CI） 0.10-0.83，P = .021]。在应用多重插补和方法校正指征混杂后，这种关联仍然存在（插补数据的逆概率加权模型：OR 0.47,95% CI 0.31-0.70，P < 0.001）。 溴隐亭组 6.0% 的患者观察到血栓栓塞事件，而标准护理组为 5.6% （P = .900）。结论 在 PPCM 妇女中，除标准护理外，溴隐亭治疗与 6 个月后更好的孕产妇结局相关。