ESC Heart Failure最新文献

Bromocriptine has been proposed as a disease-modifying therapy for peripartum cardiomyopathy (PPCM). The long-term outcomes of bromocriptine use remain uncertain. We conducted a systematic review, meta-analysis and trial sequential analysis (TSA) to assess the long-term efficacy and safety of bromocriptine in combination with standard care versus standard care alone in patients with PPCM. We systematically searched PubMed, Embase and Cochrane up until March 2025 for published studies comparing bromocriptine plus standard care with standard care alone in patients with PPCM. The outcomes included changes in left ventricular (LV) ejection fraction, LV end-systolic and end-diastolic dimensions, major adverse cardiovascular events (MACE), all-cause mortality and rehospitalization. We computed mean differences (MDs) for continuous outcomes and odds ratios (ORs) for binary endpoints with 95% confidence intervals (CIs). We used TSA to assess the conclusiveness of the available evidence. A total of 12 studies [2 randomized controlled trials (RCTs) and 10 observational studies] and 1765 patients (age range 29–33.8 years) were included, of whom 474 (26.9%) received bromocriptine with standard care and 1291 (73.1%) received standard care alone. Compared with standard care alone, bromocriptine with standard care was associated with a significant improvement in LV ejection fraction (MD 9.98%; 95% CI: 2.86 to 17.10; P < 0.001), LV end-diastolic diameter (MD −2.51 cm; 95% CI: −4.23 to −0.79; P = 0.004), and LV end-systolic diameter (MD −5.61 cm; 95% CI: −10.03 to −1.18; P = 0.010). The proportion of patients with improved LV function was higher in those who received bromocriptine with standard care than in those who received standard care alone (OR 0.35; 95% CI: 0.16 to 0.75; P = 0.007). There were no significant differences between groups regarding the incidence of MACE, all-cause mortality or heart failure rehospitalization. The TSA showed that LV ejection fraction and diastolic dimension reached the required information size (RIS); however, only LV ejection fraction crossed the monitoring boundary before the full sample size was achieved. In this meta-analysis with TSA, the use of bromocriptine with standard care was associated with improved LV function and remodelling in patients with PPCM compared with standard care alone, with a similar effect on mortality and re-hospitalization. TSA indicated that current evidence is promising, but larger and adequately powered randomized trials are needed to confirm bromocriptine's cardioprotective effects.

Cardiovascular disease is a leading cause of maternal morbidity and mortality. As cardio-obstetric care evolves, digital health technologies including telehealth, wearable devices and remote monitoring are playing an increasingly critical role. These innovations have the potential to enhance cardiovascular screening, risk assessment and disease management across the perinatal continuum. This article explores the role of digital health technologies in advancing cardio-obstetrics care. It focuses on the impact of telehealth, wearable sensors and emerging digital tools on improving maternal cardiovascular outcomes and reducing disparities in care delivery. A narrative review approach was used to synthesize existing literature and clinical insights related to telecardiology, wearable monitoring and digital innovations. Emphasis was placed on applications in pregnancy and post-partum care, as well as on evaluating implementation challenges and equity concerns. Digital health tools improve access to care and facilitate early diagnosis of cardiovascular conditions. Telehealth increases care continuity and patient satisfaction, especially in underserved populations. Wearable devices equipped with photoplethysmography and electrocardiogram sensors enable intermittent, non-invasive monitoring, aiding early detection of arrhythmias and hypertensive disorders. Furthermore, novel technologies such as digital twins, natural language processing and virtual reality show potential to personalize care and support medical education. Despite these advancements, key barriers persist, including data privacy concerns, unequal access to technology and algorithmic bias. Digital health technologies are transforming cardio-obstetrics care by enabling proactive management and expanding access. However, for these tools to deliver equitable benefits, targeted efforts are needed to address privacy, infrastructure and literacy challenges. Future efforts should focus on integrating digital health into routine maternal care, promoting digital literacy, ensuring equitable technology access and improving interoperability with electronic health records. Additionally, ongoing evaluation through clinical trials in high-risk pregnancies and ethical safeguards to mitigate algorithmic bias will be essential to ensure safe, scalable and inclusive implementation of these innovations in maternal cardiovascular care.