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Pachariyanon P, Bogabathina H, Jaisingh K, Modi M, Modi K. Long-Term Outcomes of Women With Peripartum Cardiomyopathy Having Subsequent Pregnancies. J Am Coll Cardiol 2023; 82:16-26. [PMID: 37380299 DOI: 10.1016/j.jacc.2023.04.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Long-term maternal outcomes of subsequent pregnancies (SSPs) in patients with peripartum cardiomyopathy (PPCM) have not been analyzed. OBJECTIVES The goal of this study was to evaluate the long-term survival of SSPs in women with PPCM. METHODS We conducted a retrospective review of 137 PPCMs in the registry. The clinical and echocardiographic findings were compared between the recovery group (RG) and nonrecovery group (NRG), defined as left ventricular ejection fraction ≥50% and <50% after an index of pregnancy, respectively. RESULTS Forty-five patients with SSPs were included with a mean age of 27.0 ± 6.1 years, 80% were of African American descent, and 75.6% from a low socioeconomic background. Thirty (66.7%) women were in the RG. Overall, SSPs were associated with a decrease in mean left ventricular ejection fraction from 45.1% ± 13.7% to 41.2% ± 14.5% (P = 0.009). At 5 years, adverse outcomes were significantly higher in the NRG compared with the RG (53.3% vs 20%; P = 0.04), driven by relapse PPCM (53.3% vs 20.0%; P = 0.03). Five-year all-cause mortality was 13.33% in the NRG compared with 3.33% in the RG (P = 0.25). At a median follow-up of 8 years, adverse outcomes and all-cause mortality rates were similar in the NRG and RG (53.3% vs 33.3% [P = 0.20] and 20% vs 20%, respectively). CONCLUSIONS Subsequent pregnancies in women with PPCM are associated with adverse events. The normalization of left ventricular function does not guarantee a favorable outcome in the SSPs.
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Affiliation(s)
- Pavida Pachariyanon
- Department of Cardiology, Louisiana State University Health, Shreveport, Louisiana, USA
| | - Hari Bogabathina
- Department of Cardiology, Louisiana State University Health, Shreveport, Louisiana, USA
| | - Keerthish Jaisingh
- Department of Cardiology, Louisiana State University Health, Shreveport, Louisiana, USA
| | - Morni Modi
- School of Medicine, Louisiana State University Health, Shreveport, Louisiana, USA
| | - Kalgi Modi
- Department of Cardiology, Louisiana State University Health, Shreveport, Louisiana, USA.
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2
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Carlson S, Schultz J, Ramu B, Davis MB. Peripartum Cardiomyopathy: Risks Diagnosis and Management. J Multidiscip Healthc 2023; 16:1249-1258. [PMID: 37163197 PMCID: PMC10164389 DOI: 10.2147/jmdh.s372747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
Peripartum cardiomyopathy is a rare cause of heart failure that occurs during late pregnancy or in the early postpartum period. Delays in diagnosis may occur as symptoms of heart failure mimic those of normal pregnancy. The diagnosis should be considered in any pregnant or postpartum woman with symptoms concerning for heart failure. If there are clinical concerns, labs including N-terminal pro-BNP should be checked, and an echocardiogram should be ordered to assess for systolic dysfunction. Prompt medical treatment tailored for pregnancy and lactation is essential to prevent adverse events. Outcomes are variable, including complete recovery, persistent myocardial dysfunction with heart failure symptoms, arrhythmias, thromboembolic events, and/or rapid deterioration requiring mechanical circulatory support and cardiac transplantation. It is essential that care is provided as part of a multidisciplinary cardio-obstetrics team including obstetrics, cardiology, maternal fetal medicine, anesthesiology, and nursing. All women with peripartum cardiomyopathy should have close follow-up with a cardiologist, although optimal duration of medical therapy following complete recovery is unknown. Women considering a subsequent pregnancy require preconception counseling and close collaboration between obstetrics and cardiology throughout pregnancy.
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Affiliation(s)
- Selma Carlson
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Cardiology, Minneapolis VA Medical Center, Minneapolis, MN, USA
- Correspondence: Selma Carlson, Division of Cardiology, Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA, Email
| | - Jessica Schultz
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Bhavadharini Ramu
- Division of Cardiology, Department of Medicine, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Melinda B Davis
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
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3
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Abstract
Peripartum cardiomyopathy is now increasingly recognized as a cause of heart failure in the later months of pregnancy and early postpartum period. Clinical diagnosis may be challenging as it closely resembles several common medical and obstetric complications. Complex pathogenesis, unpredictable onset, staggered recovery, and unanticipated fetomaternal risks pose unique challenge to clinicians. Prevalence seems to vary with race, geographic location, and diagnostic criteria. The presence of multiple risk factors substantially elevates the risk of PPCM. Transthoracic echocardiographic examination can exclude the majority of the mimickers. Symptomatic presentation is initially limited to, varying grades of low cardiac output syndrome. Rarely, PPCM begins with decompensated heart failure and cardiovascular collapse. Guideline-directed medical therapy involves graded initiation and titration of heart failure medications while ensuring the fetal and neonatal safety. Anesthetic and obstetric management should be individualized to improve fetomaternal outcomes. However, emergent cesarean delivery may be required in women with decompensated heart failure and cardiovascular collapse. An early institution of mechanical circulatory support has shown to improve outcome. Bromocriptine and other experimental drugs designed to target pathogenic pathway have yielded mixed results. A further change in approach to management requires a comprehensive understanding of pathophysiology and fetomaternal safety profiles of heart failure medications.
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Affiliation(s)
- Nivedita Jha
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Ajay Kumar Jha
- Cardiothoracic Division, Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
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4
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Port Z, Ammari Z, Babapoor-Farrokhran S, Bozorgnia B. Assessing the future risks of subsequent pregnancies in peripartum cardiomyopathy. Heart Fail Rev 2021; 27:779-784. [PMID: 33433773 DOI: 10.1007/s10741-021-10075-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
Peripartum cardiomyopathy is a myocardial disease process which occurs in young women either in late pregnancy or the early postpartum period. Due to the young age of women effected by this disease, many of these patients elect to pursue a subsequent pregnancy after their initial diagnosis. Currently, echocardiography is used to better elucidate the cardiovascular risks these young patients face when undergoing a subsequent pregnancy; however, the most accurate modality to determine these risks is debatable. In this review, we explore the current literature regarding the use and accuracy of resting transthoracic echocardiography, exercise stress echocardiography, and dobutamine stress echocardiography in risk stratification of a subsequent pregnancy in a patient with peripartum cardiomyopathy.
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Affiliation(s)
- Zachary Port
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA.
| | - Zaid Ammari
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA
| | | | - Behnam Bozorgnia
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA
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5
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Risk Stratification for Subsequent Pregnancy After Prior Peripartum Cardiomyopathy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00882-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Ricci F, De Innocentiis C, Verrengia E, Ceriello L, Mantini C, Pietrangelo C, Irsuti F, Gabriele S, D'Alleva A, Khanji MY, Aung N, Renda G, Cameli M, Petersen SE, Cesare ED, Gallina S. The Role of Multimodality Cardiovascular Imaging in Peripartum Cardiomyopathy. Front Cardiovasc Med 2020; 7:4. [PMID: 32133371 PMCID: PMC7041418 DOI: 10.3389/fcvm.2020.00004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/13/2020] [Indexed: 11/16/2022] Open
Abstract
The burden of pregnancy-related heart disease has dramatically increased over the last decades due to the increasing age at first pregnancy and higher prevalence of cardiovascular risk factors such as diabetes, hypertension, and obesity. Pregnancy is associated with physiological changes in the cardiovascular system, including hemodynamic, metabolic, and hormonal adaptations to meet the increased metabolic demands of the mother and fetus. It has been postulated that pregnancy may act as a cardiovascular stress test to identify women at high risk for heart disease, where the inability to adequately adapt to the physiologic stress of pregnancy may reveal the presence of genetic susceptibility to cardiovascular disease or accelerate the phenotypic expression of both inherited and acquired heart diseases, such as peripartum cardiomyopathy (PPCM). PPCM is a rare and incompletely understood clinical condition. Despite recent advances in the understanding of its pathogenesis, PPCM is not attributable to a well-defined pathological mechanism, and therefore, its diagnosis still relies on the exclusion of overlapping dilated phenotypes. Cardiac imaging plays a key role in any peripartum woman with signs and symptoms of heart failure in establishing the diagnosis, ruling out life-threatening complications, guiding therapy and conveying prognostic information. Echocardiography represents the first-line imaging technique, given its robust diagnostic yield and its favorable cost-effectiveness. Cardiovascular magnetic resonance is a biologically safe high-throughput modality that allows accurate morpho-functional assessment of the cardiovascular system in addition to the unique asset of myocardial tissue characterization as a pivotal piece of information in the pathophysiological puzzle of PPCM. In this review, we will highlight current evidence on the role of multimodality imaging in the differential diagnosis, prognostic assessment, and understanding of the pathophysiological basis of PPCM.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy.,Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden.,Casa di Cura Villa Serena, Città Sant'Angelo, Pescara, Italy
| | - Carlo De Innocentiis
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Elvira Verrengia
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Laura Ceriello
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Carla Pietrangelo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Flaviano Irsuti
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Stefano Gabriele
- Hypertension and Related Diseases Center, AOU-University of Sassari, Sassari, Italy
| | - Alberto D'Alleva
- Cardiac Intensive Care and Interventional Cardiology Unit, Santo Spirito Hospital, Pescara, Italy
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Matteo Cameli
- Department of Life, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
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7
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Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U. Peripartum Cardiomyopathy. J Am Coll Cardiol 2020; 75:207-221. [DOI: 10.1016/j.jacc.2019.11.014] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 01/13/2023]
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8
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Abstract
Peripartum cardiomyopathy (PPCM) is a rare, often dilated, cardiomyopathy with systolic dysfunction that presents in late pregnancy or, more commonly, the early postpartum period. Although the condition is prevalent worldwide, women with black ancestry seem to be at greatest risk, and the condition has a particularly high incidence in Nigeria and Haiti. Other risk factors include pre-eclampsia, advanced maternal age, and multiple gestation pregnancy. Although the complete pathophysiology of peripartum cardiomyopathy remains unclear, research over the past decade suggests the importance of vasculo-hormonal pathways in women with underlying susceptibility. At least some women with the condition harbor an underlying sarcomere gene mutation. More than half of affected women recover systolic function, although some are left with a chronic cardiomyopathy, and a minority requires mechanical support or cardiac transplantation (or both). Other potential complications include thromboembolism and arrhythmia. Currently, management entails standard treatments for heart failure with reduced ejection fraction, with attention to minimizing potential adverse effects on the fetus in women who are still pregnant. Bromocriptine is one potential disease specific treatment under investigation. In this review, we summarize the current literature on peripartum cardiomyopathy, as well as gaps in the understanding of this condition and future research directions.
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Affiliation(s)
- Michael C Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Michael M Givertz
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
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9
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Sliwa K, Petrie MC, Hilfiker-Kleiner D, Mebazaa A, Jackson A, Johnson MR, van der Meer P, Mbakwem A, Bauersachs J. Long-term prognosis, subsequent pregnancy, contraception and overall management of peripartum cardiomyopathy: practical guidance paper from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy. Eur J Heart Fail 2018; 20:951-962. [PMID: 29578284 DOI: 10.1002/ejhf.1178] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 02/11/2018] [Accepted: 02/20/2018] [Indexed: 12/28/2022] Open
Abstract
Peripartum cardiomyopathy is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause for heart failure is identified. Outcome varies from full recovery to residual left ventricular systolic dysfunction and even death. Many women return to their physician to acquire information on their long-term prognosis, to seek medical advice regarding contraception, or when planning a subsequent pregnancy. This position paper summarizes current evidence for long-term outcome, risk stratification of further pregnancies and overall management. Based on the best available evidence, as well as the clinical experience of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy members, a consensus on pre- and postpartum management algorithms for women undergoing a subsequent pregnancy is presented.
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Affiliation(s)
- Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine & Cardiology, Faculty of Health Sciences, University of Cape Town, South Africa.,Mary McKillop Institute, ACU, Melbourne, Australia
| | | | | | - Alexandre Mebazaa
- Hôpital Lariboisière, Université Paris Diderot, Inserm U942, Paris, France
| | | | - Mark R Johnson
- Department of Obstetrics, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Amam Mbakwem
- Department of Cardiology, Lagos University Hospital, Lagos
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Medizinische Hochschule Hannover, Hannover, Germany
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10
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11
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Nesiritide Therapy Is Associated With Better Clinical Outcomes Than Dobutamine Therapy in Heart Failure. Am J Ther 2017; 24:e181-e188. [PMID: 26164026 DOI: 10.1097/mjt.0000000000000278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
To evaluate the therapeutic effects of dobutamine and nesiritide in the treatment of heart failure (HF), a meta-analysis of published studies was conducted. Computerized bibliographic databases in Chinese and English languages were carefully searched to identify the relevant literature. A total of 6 cohort studies were enrolled in current meta-analysis for statistical analyses. The effect of dobutamine and nesiritide in patients with HF was estimated by odds ratios (ORs) and 95% confidence interval (CI). Our results revealed a significantly higher survival rate in nesiritide-treated patients, compared with those treated with dobutamine (OR = 1.97; 95% CI, 1.43-2.71; P < 0.001). In addition, a lower readmission rate was also associated with the nesiritide-treated group in comparison with the dobutamine-treated group (OR = 1.96; 95% CI, 1.39-2.78; P < 0.001). A stratified analysis revealed that the subgroup of patients with HF treated with nesiritide showed higher survival outcomes than those patients with HF treated with dobutamine when follow-up period was greater than 6 months (OR = 1.70; 95% CI, 1.21-2.38; P = 0.002) but not under 6 months (P > 0.05). This indicated that nesiritide treatment had longer term benefits as well. Interestingly, based on the reason for readmission, a subgroup analysis of the HF subgroup and the "all-cause" subgroup showed that higher readmission rates were associated with dobutamine treatment in both subgroups (HF: OR = 2.71; 95% CI, = 1.51-4.83; P = 0.001; all-cause: OR = 1.64; 95% CI, 1.06-2.53; P = 0.026; respectively). Our results suggest that nesiritide therapy is associated with a lower in-hospital mortality rates and decreased readmission rates compared with dobutamine treatment in patients with HF.
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12
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Cuenza LR, Manapat N, Jalique JRK. Clinical Profi le and Predictors of Outcomes of Patients with Peripartum Cardiomyopathy: The Philippine Heart Center Experience. ACTA ACUST UNITED AC 2016; 24:9. [PMID: 27942536 PMCID: PMC5122607 DOI: 10.7603/s40602-016-0009-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy is a rare form of dilated cardiomyopathy characterized by heart failure and left ventricular dysfunction associated with pregnancy. While clinical characteristics of these patients have been previously described in literature, there is limited data regarding the natural history and predictors of outcomes of these patients in Asia, most specifi cally in Filipino patients. METHODS Clinical and echocardiographic data of 39 patients diagnosed with peripartum cardiomyopathy were analyzed. Patients were followed up for the occurrence of death and major adverse events (MAE) and outcomes were correlated with patient variables. RESULTS The mean age of the patients was 28.4 ± 6.9 and the mean ejection fraction (EF) was 27.8 ± 8.4%. Heart failure was the most common symptom (98%) while arrhythmia was the initial presentation in 5 patients (12.8%). 14 patients had recovery of ejection fraction in 6 months (39%) with a mean EF of 55.5 ± 6.3. 16 patients had an initial EF of <25% (41%) and only 2 patients in this subgroup experienced improvement in EF. 29 patients experienced death and/or MAEs (74.4%). Multivariate analysis showed that an EF of <25% (HR 12.0,p=0.019), recovery of LV function (HR 0.23,p=0.05) and improvement of EF in 6 months (HR 0.32,p=0.024) were signifi cant predictors of MAEs. Kaplan Meier curves showed that patients whose ejection fraction was <25% had a 50% incidence of MAEs in 1 year with an increasing trend. Patients whose EF recovered in 6 months experienced a 60% freedom from MAE for almost 6 years. Patients with an EF of <25% had a mortality rate of 50% in two years. Patients with an EF of >25% had a 90% likelihood of survival for 8 years with a higher trend of mortality for patients whose EF did not recover in 6 months. CONCLUSION Peripartum cardiomyopathy is associated with signifi cant morbidity and mortality. The degree of left ventricular dysfunction on presentation as well as improvement of EF within 6 months were predictive for the occurrence of death and major adverse events. This study emphasizes the need for aggressive treatment as well as clinical and echocardiographic follow up early in the course of disease in order to improve outcomes.
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Affiliation(s)
- Lucky R Cuenza
- Clinical Fellow in Cardiology, Philippine Heart Center and National Heart Centre, East Avenue, Quezon City, Philippines 1100 ; National Heart Centre, Singapore, Singapore
| | - Normita Manapat
- Department of Emergency and Ambulatory Services, Philippine Heart Center, Quezon City, Philippines
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13
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Wang XC, Zhu DM, Shan YX. Dobutamine Therapy is Associated with Worse Clinical Outcomes Compared with Nesiritide Therapy for Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis. Am J Cardiovasc Drugs 2015; 15:429-37. [PMID: 26123415 DOI: 10.1007/s40256-015-0134-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Inotropes and natriuretic peptides are essential components of current therapeutic options for acute decompensated heart failure (ADHF). This systematic review examines the therapeutic effectiveness of dobutamine and brain natriuretic peptide, nesiritide, in reducing mortality and readmission rates for ADHF treatment. METHODS Published studies related to dobutamine and nesiritide therapy in ADHF were identified via an exhaustive search of scientific literature databases. The identified studies, published between 2002 and 2012, were carefully screened based on our predefined inclusion criteria. Selected studies were pooled, and odds ratios (ORs) and 95% confidence intervals (95% CI) for each outcome were calculated. Subgroup analysis was conducted to assess the influence of ethnicity on the study outcome. RESULTS Seven cohort studies were selected for this meta-analysis. These seven studies included 959 ADHF patients who underwent nesiritide treatment and 1748 ADHF patients who received dobutamine therapy. Our meta-analysis revealed a significantly lower survival rate in dobutamine-treated patients compared with nesiritide-treated patients (OR 0.48, 95% CI 0.36-0.63, P < 0.001). Additionally, a markedly higher readmission rate was associated with dobutamine treatment compared with nesiritide treatment (OR 0.52, 95% CI 0.36-0.73, P < 0.001). A stratified analysis based on ethnicity revealed a significantly lower survival in dobutamine-treated ADHF patients in Caucasian and mixed populations compared with nesiritide treatment (Caucasian: OR 0.60, 95% CI 0.38-0.94, P = 0.024; Mixed: OR 0.38, 95% CI 0.26-0.56, P < 0.001). However, a similar association was not detected in Asian populations (P = 0.738). Further, dobutamine-treated ADHF patients displayed higher readmission rates than did nesiritide-treated patients in both Caucasian and mixed-race populations (all P < 0.05). CONCLUSIONS Our study suggests that dobutamine therapy is associated with poorer outcomes, with higher in-hospital mortality rates and increased readmission rates compared with nesiritide therapy in ADHF patients. Thus, current treatment strategies need to be redesigned for better outcomes.
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Affiliation(s)
- Xiao-Chen Wang
- Department of Thoracic and Cardiac Surgery, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
- Department of Thoracic and Cardiac Surgery, The Affiliated Jiangyin Hospital of Southest University Medical College, Jiangyin, People's Republic of China
| | - Dong-Min Zhu
- Department of Cardiology, Nursing College of Nanjing Medical University, Nanjing, People's Republic of China
- Department of Cardiology, The Affiliated Jiangyin Hospital of Southest University Medical College, Jiangyin, Jiangyin, People's Republic of China
| | - Yu-Xuan Shan
- Department of Cardiology, Linfen People's Hospital, No. 17, Liberation Road, Linfen, 041000, People's Republic of China.
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14
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Lv MY, Deng SL, Long XF. Retraction. rhBNP therapy can improve clinical outcomes and reduce in-hospital mortality compared with dobutamine in heart failure patients: a meta-analysis. Br J Clin Pharmacol 2015; 81:174-85. [PMID: 26382927 DOI: 10.1111/bcp.12788] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/11/2015] [Accepted: 09/15/2015] [Indexed: 12/27/2022] Open
Abstract
AIMS A meta-analysis was performed to compare the therapeutic outcomes in patients treated for heart failure (HF) with recombinant human brain natriuretic peptide (rhBNP) and dobutamine. METHODS PubMed, Embase and the Chinese Biomedical Database were exhaustively searched to identify studies relevant to this meta-analysis. Eight cohort studies were found suitable for inclusion. Data regarding trial validity, methodological processes and clinical outcomes were extracted. RESULTS Patients treated with rhBNP showed statistically significant reduction of in-hospital mortality and re-admission rates compared with the dobutamine treated patient group (both P < 0.05). Further, the rhBNP treated patient group showed higher survival outcomes, compared with dobutamine treated patients, when the post-treatment follow-up period was longer than 6 months (P < 0.05). Stratified analysis based on ethnicity showed a dramatic decrease of in-hospital mortality among mixed race HF patients receiving rhBNP treatment (P < 0.05), but such decreases were not statistically significant in Asian and Caucasian populations (both P > 0.05). On the other hand, re-admission rates were significantly lower in rhBNP treated Caucasian and mixed race populations (both P < 0.05). Notably, in rhBNP treated group, dose levels of 0.015 and 0.03 incrementally lowered the re-admission rates, displaying dose effect, and the re-admission rates at both rhBNP doses were significantly lower than the dobutamine treated group (both P < 0.05). CONCLUSIONS Our meta-analysis results suggested that rhBNP therapy is associated with lower in-hospital mortality and re-admission rates in HF patients compared to the dobutamine regimen. Nevertheless, large scale prospective, randomized trials are necessary to confirm these findings.
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Affiliation(s)
- Ming-Yi Lv
- Department of Internal Medicine, ICU, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116000, Liaoning Province, P.R. China
| | - Shu-Ling Deng
- Department of Internal Medicine, ICU, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116000, Liaoning Province, P.R. China
| | - Xiao-Feng Long
- Department of Internal Medicine, ICU, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116000, Liaoning Province, P.R. China
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