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MHH researchers publish two new studies on treatment with bromocriptine and on the possibility of a subsequent pregnancy in women with PPCM
Peripartum cardiac insufficiency (PPCM) is a rare but life-threatening condition that can affect previously heart-healthy women a few weeks before or after the birth of a child. For unknown reasons, the left ventricle is severely restricted in its pumping action. The Department of Cardiology and Angiology at the Hannover Medical School (MHH) is Europe's leading PPCM centre and provides care for patients in a specialised outpatient clinic with a multi-professional team from the fields of cardiology, obstetrics and neonatology. The disease is not only treated in the clinic, but is also one of its research priorities, with a very large PPCM registry containing data and biomaterials from more than 200 patients. MHH President Professor Denise Hilfiker-Kleiner established the research field at the MHH more than 20 years ago and, together with clinic director Professor Dr Johann Bauersachs and their teams, published fundamental scientific findings about PPCM.
In 2007, Professor Hilfiker-Kleiner and her research group discovered that in affected women, the breastfeeding hormone prolactin is broken down into a metabolite that damages blood vessels, causing heart failure. Various pilot studies and case reports suggested that blocking prolactin with the weaning drug bromocriptine promotes the healing of PPCM. Ten years later, a scientific study showed that administering bromocriptine for seven days in addition to heart failure therapy is sufficient. In addition to new treatment options, researchers are addressing the question of how high the risk is of recurrence or progression of heart failure in mothers who become pregnant again after PPCM.
Professor Hilfiker-Kleiner and Professor Bauersachs have now published new studies on both topics in the European Heart Journal. The first study shows that treatment with bromocriptine is effective as an addition to the usual therapy for heart failure without increasing the risk of thrombosis. The second study shows that even women with mild persistent heart failure can have a subsequent pregnancy with close cardiological care.
Bromocriptine improves heart health
PPCM affects one in 1,500 to 2,000 pregnant women. This life-threatening heart condition strikes without warning and can quickly lead to severe heart failure and even death. The symptoms are similar to those that often occur towards the end of a pregnancy and shortly after delivery: exhaustion, shortness of breath, coughing, weight gain, particularly due to fluid retention in the lungs and legs, and tachycardia. PPCM is therefore often not recognised and probably occurs more frequently than assumed. However, heart failure can be clearly demonstrated with the help of a cardiac ultrasound and certain marker proteins in the blood. When treated in time, the heart often recovers completely, but heart failure may also remain.
‘Bromocriptine is a promising treatment option for PPCM in addition to therapy with the medications usually used for heart failure,’ says Professor Hilfiker-Kleiner. ’In a large, global PPCM registry with 552 PPCM patients, we confirmed the efficacy of bromocriptine and showed that it significantly improves maternal cardiac health.’ Case reports of an increased risk of vascular occlusion during treatment with the weaning drug have not been confirmed. ‘These data not only confirm the efficacy but also the safety of our therapeutic approach,’ explains the PPCM expert.
Lower risk for subsequent pregnancy than expected
The second study addressed the question of whether women with PPCM should generally be advised against becoming pregnant again. The participants were patients from the Global PPCM Registry of the European Society of Cardiology. ‘In previous studies, we showed that patients who become pregnant again with severely reduced heart function have a higher risk of a deterioration in the pumping function of the heart in a subsequent pregnancy,’ says Professor Bauersachs. ’However, in the current study, we found that the risk of the mothers becoming seriously ill or even dying was lower than expected.’ Even in women who continued to suffer from mild heart failure after childbirth, the condition of the heart did not worsen after a subsequent pregnancy.
‘The data from our latest study suggest that a subsequent pregnancy in PPCM patients with a justifiable risk seems possible not only when heart function has recovered, but also when it is only slightly restricted,’ says Professor Bauersachs. However, this relaxation can only be considered if the patient continues to be cared for by an experienced, interdisciplinary medical team and receives appropriate drug treatment. ‘This is the case in our specialised outpatient clinic, where we have been successfully treating such women for years,’ emphasises Professor Bauersachs.
SERVICE:
The original paper on the effectiveness of bromocriptine ‘Bromocriptine treatment and outcomes in peripartum cardiomyopathy: the EORP PPCM registry’ can be found here:
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehae559...
The original paper on the risks of a subsequent pregnancy after PPCM ‘Subsequent pregnancies in women with peripartum cardiomyopathy: prospective longitudinal data from the global ESC EORP PPCM Registry’ can be found here:
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf006...
For further information, please contact Professor Denise Hilfiker-Kleiner, hilfiker-kleiner@mh-hannover.de, or Professor Dr Johann Bauersachs, bauersachs.johann@mh-hannover.de.
Leaders in research into pregnancy-related cardiac insufficiency (PPCM) for many years: Professor De ...
Copyright: Karin Kaiser/MHH
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