Cabergoline as an adjuvant to standard heart failure treatment in peripartum cardiomyopathy: A case report and review of the literature

Caruso, Giuseppe; Scopelliti, Annalisa; Scaramuzzino, Sara; Perrone, Giuseppina; Gabriela, Paola; Palaia, Innocenza; Muzii, Ludovico; Panici, Pierluigi Benedetti; Brunelli, Roberto

doi:10.1016/j.crwh.2020.e00277

Cited by 9 publications

(7 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Cabergoline is also superior in normalizing prolactin levels and is better tolerated than bromocriptine, with fewer adverse events, particularly nausea and vomiting (14,15). Notably, some reports showed that cabergoline contributed to improvements in the left ventricular function in patients with PPCM (16,17). In the present case, cabergoline helped maintain a low level of prolactin and immediately suppressed breastfeeding secretion without any side effects.…”

Section: Discussionsupporting

confidence: 52%

Peripartum Cardiomyopathy with the Cardiac Function Restored by Cabergoline

et al. 2023

View full text Add to dashboard Cite

Peripartum cardiomyopathy (PPCM) is a left ventricular systolic dysfunction associated with heart failure (HF) in late-term pregnancy or peripartum. A 29-year-old pregnant woman with no history of cardiac disease noted lower extremity edema around 34 weeks' gestation with significant weight gain. She delivered twins via caesarean section, and the edema regressed postpartum. On postpartum day 4, however, she experienced difficulty breathing at night and was diagnosed with HF owing to PPCM. HF treatment along with cabergoline was initiated. With low prolactin blood levels, her symptoms and cardiac function improved over time. This case demonstrated the usefulness of anti-prolactin therapy with cabergoline in PPCM.

show abstract

Section: Discussionsupporting

confidence: 52%

Peripartum Cardiomyopathy with the Cardiac Function Restored by Cabergoline

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Our data are supported by promising results in several single case reports of PPCM patients treated with cabergoline, showing similar positive effects on the clinical course without the occurrence of adverse events. 26 , 27 , 28 , 29 Furthermore, in a retrospective study including 24 Danish PPCM patients treated with cabergoline, the treatment was associated with an increased chance of full cardiac recovery, 30 further emphasizing the positive effects of cabergoline treatment in PPCM patients regarding the cardiac outcome.…”

Section: Discussionmentioning

confidence: 99%

Cabergoline treatment promotes myocardial recovery in peripartum cardiomyopathy

et al. 2022

View full text Add to dashboard Cite

Aims Peripartum cardiomyopathy (PPCM) is a rare heart disease, occurring in previously heart‐healthy women during the last month of pregnancy or the first months after delivery due to left ventricular (LV) systolic dysfunction. A common pathomechanistic pathway of PPCM includes increased oxidative stress and the subsequent generation of a cleaved prolactin fragment (16 kDa PRL), which promotes the onset of heart failure (HF) in a microRNA (miR)‐146a‐dependent manner. Inhibition of prolactin secretion with the dopamine D2 receptor (D2R) agonist bromocriptine combined with standard HF therapy supports cardiac recovery. This study examined whether treatment with the more selective D2R agonist cabergoline prevents HF development in an experimental PPCM mouse model and might be used as an alternative treatment regime for PPCM. Methods and results Postpartum (PP) female PPCM‐prone mice with a cardiomyocyte restricted STAT3‐deficiency (αMHC‐Cre tg/+ ; Stat3 fl/fl ; CKO) were treated over two consecutive nursing periods with cabergoline (CKO Cab, 0.5 mg/kg/day) and were compared with bromocriptine treated CKO (CKO Br) and postpartum‐matched WT and CKO mice. Cabergoline treatment in CKO PP mice preserved cardiac function [fractional shortening (FS): CKO Cab: 34.5 ± 9.4% vs. CKO: 22.1 ± 9%, P < 0.05] and prevented the development of cardiac hypertrophy, fibrosis, and inflammation as effective as bromocriptine therapy (FS: CKO Br: 33.4 ± 5.6%). The myocardial up‐regulation of the PPCM biomarkers plasminogen inhibitor activator 1 (PAI‐1) and miR‐146a were prevented by both cabergoline and bromocriptine therapy. A small cohort of three PPCM patients from the German PPCM Registry was treated with cabergoline (1 mg per week for 2 weeks, followed by 0.5 mg per week for another 6 weeks) due to a temporary unavailability of bromocriptine. All PPCM patients initially presented with a severely reduced LV ejection fraction (LVEF: 26 ± 2%). However, at 6 months of follow‐up, LV function (LVEF: 56 ± 2%) fully recovered in all three PPCM patients, and no adverse events were detected. Conclusions In the experimental PPCM mouse model, the selective D2R agonist cabergoline prevents the onset of postpartum HF similar to bromocriptine. In PPCM patients, cabergoline treatment was safe and effective as all patients fully recovered. Cabergoline might serve as a promising alternative to bromocriptine. However, these findings are based on experimental data and a small case series and thus have to be interpreted with caution and should be validated in a larger clinical trial.

show abstract

“…Dado que la bromocriptina presenta una alta tasa de efectos adversos incluidos eventos trombóticos e isquémicos, hay estudios que han evaluado la utilidad de la Cabergolina, por su menor tasa de efectos secundarios, mejor tolerancia oral, mayor afinidad por receptores D2, un efecto inhibidor de PRL más alto, y sólo requiere 1 dosis semanal, mejorando la adherencia al tratamiento. Además, tiene un mayor impacto positivo en vías metabólicas con reducción de los niveles de triglicéridos, ácidos grasos libres, IGF-1, Proteína C reactiva, homocisteína, fibrinógeno y ácido úrico, e incrementa el HDL y la Vit-D 30 . Así, existen algunos reportes de caso con buenos resultados, pero bajo grado de evidencia [30][31][32] .…”

Section: Manejounclassified

“…Además, tiene un mayor impacto positivo en vías metabólicas con reducción de los niveles de triglicéridos, ácidos grasos libres, IGF-1, Proteína C reactiva, homocisteína, fibrinógeno y ácido úrico, e incrementa el HDL y la Vit-D 30 . Así, existen algunos reportes de caso con buenos resultados, pero bajo grado de evidencia [30][31][32] . Dado que nuestro país tiene un quiebre de stock de bromocriptina, a pesar de la escasa evidencia y la ausencia de estudios randomizados, para nuestra población se podría sugerir el uso de cabergo-lina, dado su mayor eficacia terapéutica, perfil más seguro y farmacocinética favorable, como una opción de tratamiento alternativo en la MCPP.…”

Section: Manejounclassified