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Early diagnosis and treatment with bromocriptine should reduce deaths and improve outcomes of women with peripartum cardiomyopathy (PPCM), according to a late-breaking registry study, presented yesterday by Professor Karen Sliwa (University of Cape Town, South Africa) (LBT17).
In many parts of the world, PPCM is often poorly recognised and inappropriately diagnosed, explains Prof. Sliwa. This is not helped by the misperception that PPCM is confined mainly to African women. In 2009, the ESC EURObservational Research Programme PeriPartum CardioMyopathy Registry was formed to create global awareness and to establish the epidemiology and treatment of PPCM.
Yesterday’s presentation from this large, 43-country registry represents the first global report on PPCM. Of the 739 PPCM cases reported, 33% were in Europe, 29% in Africa, 22% in Asia-Pacific and 15% in the Middle East.
The registry results are proof that PPCM is a global condition
There was no intercountry difference in the mean age of patients (31 years) or in signs and symptoms at presentation.
However, probably as a result of regional differences in disease awareness, the time to diagnosis post-presentation varied, being most rapid in Africa (19.4 days), followed by Europe (20.6 days) and the Middle East (23.5 days): in Asia-Pacific the time to diagnosis (38.3 days) was almost double that in Africa.
While post-diagnosis treatment in all regions was in line with general guideline recommendations for heart failure, only 15% of patients received bromocriptine, which inhibits release of the prolactin variant thought to be a major contributor to PPCM-associated cardiac damage. Prof. Silwa thinks this is not surprising, given that bromocriptine was only included in ESC Guideline recommendations in August 2018.1 The benefits of bromocriptine in preventing death and improving ventricular function in PPCM have been demonstrated in a randomised clinical trial,2 although some clinicians are concerned about a potential association with stroke. In the present study, there was no increase in the incidence of thromboembolic events in patients receiving bromocriptine.
Overall, 4% of patients died within six months and Prof. Sliwa cautions that more are likely to die over the next few years. In addition, more than one-third of patients had poor myocardial recovery (left ventricular ejection fraction ≤35% or ventricular assist device). “These are alarming findings for such a young population and are due largely to the delayed diagnosis of the condition,” says Prof. Sliwa. “We hope that the registry findings will raise awareness of PPCM among clinicians globally and lead to a prompt diagnosis and improved outcomes for these patients.”
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