Valvular heart disease in Parkinson's disease vs. controls: An echocardiographic study

Abstract

Restrictive valvulopathy has been reported in association with dopamine agonist therapy in parkinsonian patients. The majority of reports have been related to pergolide, but anecdotal cases following treatment with bromocriptine or cabergoline have also been presented. It is presently unclear whether the potential induction of restrictive cardiac valvulopathy is a class effect of all dopamine agonists or if there is a differential risk between ergot and nonergot compounds. In this study, the frequency of a valvular regurgitation as assessed by routine transthoracic echocardiography was compared between 75 patients with Parkinson's disease (PD) treated with pergolide (n = 29), cabergoline (n = 13), pramipexole or ropinirole (n = 33), and 49 age-matched nonparkinsonian controls. The exposure to pergolide and cabergoline was associated with higher frequencies of valvular regurgitation grades 2 and 3 (31% and 47%) compared with age-matched controls (13%), while there was no increase of valvular regurgitation grades 2 and 3 in patients treated with nonergot compounds (10%). Evidence for restrictive valvulopathy was found in one patient treated with pergolide and cabergoline each. While this study shows similarly increased frequencies of valvular regurgitation in patients treated with the ergot agonists pergolide and cabergoline in comparison to both normal controls and patients treated with nonergot agonists, evidence for restrictive valvulopathy was only found in two cases. These results highlight the need for further prospective studies of the prevalence and underlying mechanisms of cardiac valvulopathy in PD patients treated with different dopamine agonists.

Evaluation of the valvular and biventricular functions in Parkinson patients using ergotamine-derived dopamine agonist: an observational study

“…Moreover composite regurgitation score was higher in patients using cabergoline which was associated both with duration and cumulative dose of cabergoline therapy as in line with previous studies (15,18). In addition to valvular regurgitation, morphologic features including leaflet and subvalvular apparatus thickening were more prevalent in patient using cabergoline similar to previous studies (19).…”

Valvular heart disease in patients with Parkinson’s disease treated with pergolide. Course following treatment modifications

“…■ Key words Parkinson's disease · pergolide · valvular heart disease · echocardiography 9] have focused on the more specific restrictive valvulopathy and reported frequencies of 33 % [1], 3 % [7], and 0 % [9], respectively. No study has systematically examined the course of valvulopathy following pergolide discontinuation.…”

A Prospective, Multicenter, 2-Year Echocardiographic Study on Valvular Heart Disease in Parkinson's Disease Patients Taking Rotigotine and Other non-Ergot Dopamine Agonists

“…Several echocardiographic prevalence studies reported increased risk of valvular heart disease (VHD) in patients taking ergot DAs (cabergoline, pergolide) compared to non-ergot DAs (pramipexole, ropinirole) [7][8][9] and an association between cumulative dose and severity of valve regurgitation [9]. A systematic review confirmed these findings assessing an increased risk of cardiac valve regurgitation associated with the use of ergot DAs and not of non-ergot DAs [10].…”