ergoline and Aortic-Valve-Insufficiency

The effects of cabergoline on cardiac valves have been extensively studied in Parkinson's disease and hyperprolactinemia but not in acromegaly, a condition at risk of cardiac valve abnormalities.. We examined the prevalence and incidence of heart valve disease and regurgitation in a series of patients with acromegaly treated with cabergoline, by comparison with matched patients who had never received this drug.. We conducted a cross-sectional and longitudinal study in a single referral center.. Forty-two patients who had received cabergoline at a median cumulative dose of 203 mg for a median of 35 months were compared to 46 patients with acromegaly who had never received cabergoline and who were matched for age, sex, and disease duration. A subgroup of patients receiving cabergoline (n = 26) was evaluated longitudinally before and during cabergoline treatment and compared to a group not receiving cabergoline and followed during the same period (n = 26). Two-dimensional and Doppler echocardiographic findings were reviewed by two cardiologists blinded to treatment.. Demographic and clinical features were not significantly different between the groups. Compared to acromegalic controls, patients receiving cabergoline did not have a higher prevalence or incidence of valve abnormalities. A slightly higher prevalence of aortic valve regurgitation and remodeling was found in the controls relative to the cabergoline-treated patients (P < 0.02 and P < 0.03, respectively), but this was related to the presence of aortic dilatation.. Cabergoline therapy is not associated with an increased risk of cardiac valve regurgitation or remodeling in acromegalic patients at the doses used in this study.

Topics: Acromegaly; Adolescent; Adult; Aged; Aortic Valve Insufficiency; Cabergoline; Cross-Sectional Studies; Dopamine Agonists; Echocardiography; Echocardiography, Doppler; Ergolines; Female; Heart Valve Diseases; Heart Valves; Humans; Hypertrophy, Left Ventricular; Longitudinal Studies; Male; Middle Aged; Mitral Valve Insufficiency; Retrospective Studies; Tricuspid Valve Insufficiency; Young Adult

We report the case of a restrictive aortic insufficiency diagnosed on a 53-year old woman while being treated by low dose of cabergoline for hyperprolactinemia. Such valves involvements had already been described with cabergoline and other dopamine agonists, drugs the patient was previously exposed to. However, chronology of events leads us to suspect cabergoline, although such effects had only been described with much higher doses. This case may recommend to perform echocardiograms upon patients treated by cabergoline, and probably such a caution may be enforced in patients previously exposed to other dopamine agonists. On another hand, the diagnostic of a restrictive valvulopathy may lead to suspect a iatrogenic origin including dopamine agonists.

Topics: Aortic Valve Insufficiency; Cabergoline; Ergolines; Female; Humans; Hyperprolactinemia; Middle Aged

The use of high doses of the ergot-derived dopamine agonist cabergoline (> 3 mg/day), especially with cumulative doses > 4000 mg, has been associated with an increase in cardiac valvular thickening and significant (moderate to severe) regurgitation. Whether lower doses commonly used in the treatment of prolactinomas (0.25-3 mg/week) are also associated with significant valvulopathy is controversial. The mitral valve tenting area, a subclinical index of leaflet stiffening, has also been correlated with the cumulative dose of cabergoline and severity of valvular regurgitation.. We performed transthoracic echocardiography (TTE) on 50 prolactinoma patients (48% macroprolactinomas, 52% microprolactinomas, 30 male, 20 female, age 51.2 +/- 2.2 years, mean +/- SEM) who had been taking cabergoline for 6.6 +/- 0.5 years (range 1-13 years) with cumulative doses of 443 +/- 53 mg, to determine the prevalence of significant valvular thickening (> 0.5 cm) and regurgitation, and measured the mitral valve tenting area and height. The results were compared to those from age- and sex-matched controls with normal left ventricular function.. No significant valvular thickening or regurgitation of any valve was detected in the prolactinoma group and the prevalence of mild valvular regurgitation was not higher than in the case-control group. The mitral valve tenting area and height were not significantly greater than in the control group. There was no correlation between tenting area or height and cumulative cabergoline dose.. We found no evidence of increased mitral valve tenting area/height, valvular thickening or significant regurgitation with the long-term administration of the commonly used doses of cabergoline to treat prolactinoma.

Topics: Aortic Valve Insufficiency; Cabergoline; Calcinosis; Echocardiography; Ergolines; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Prolactinoma; Ventricular Dysfunction, Left

Topics: Antiparkinson Agents; Aortic Valve Insufficiency; Cabergoline; Dopamine Agonists; Ergolines; Health Knowledge, Attitudes, Practice; Humans; Parkinson Disease; Pergolide

Topics: Aortic Valve Insufficiency; Cabergoline; Dopamine Agonists; Dyspnea; Ergolines; Humans; Lewy Body Disease; Male; Middle Aged; Ultrasonography

To investigate the frequency of cardiac valve regurgitation related with low dose dopamine agonists in patients with Parkinson's disease (PD), echocardiograms were analyzed in 527 consecutive PD patients (448 patients treated with dopamine agonists, 79 patients never treated with dopamine agonists as age-matched controls). The frequency of mild or above mild regurgitation of the aortic valve (AR) was significantly higher in the cabergoline group (13.7%, P < 0.05) compared with the controls (2.5%). Odds ratio adjusted by age and sex for AR was significantly higher in the cabergoline group (OR, 6.45; 95% CI, 1.46-28.60; P = 0.01): odds ratio was significantly higher in patients treated with higher daily doses (OR, 14.41; 95% CI, 3.08-67.38; P = 0.0007) and higher cumulative doses (OR, 15.29; 95% CI, 3.19-73.18; P = 0.0006). No statistical difference was identified in the frequency of the tricuspid and mitral regurgitation. None of the other dopamine agonist groups including pergolide gave higher frequency or higher odds ratio compared with the controls. None of our patients showed severe regurgitation or was operated for valvular heart disease. The question as to whether or not longer duration of low dose dopamine agonist treatment would yield the same results needs further studies.

Topics: Aged; Aortic Valve Insufficiency; Azepines; Benzothiazoles; Bromocriptine; Cabergoline; Dopamine Agonists; Ergolines; Female; Humans; Male; Mitral Valve Insufficiency; Parkinson Disease; Pergolide; Pramipexole; Prevalence

Dopamine agonists have been reported to increase the risk of cardiac valve regurgitation in patients with Parkinson's disease. However, it is unknown whether these drugs might be harmful for patients with hyperprolactinaemia (HyperPRL). The aim of the study was to evaluate whether HyperPRL patients treated with dopamine agonists had a higher prevalence of cardiac valves regurgitation than that of general population.. One hundred consecutive patients (79 women, 21 men, mean age 41 +/- 13 years) with HyperPRL during treatment with cabergoline were enrolled in an observational case-control study and compared with 100 matched normal subjects (controls). Valve regurgitation was assessed by echocardiography according to the American Society of Echocardiography recommendations.. Seven HyperPRL patients (7%) and six controls (6%) had moderate (grade 3) regurgitation in any valve (p = 0.980). All were asymptomatic and had no signs of cardiac disease. Mean duration of cabergoline treatment was 67 +/- 39 months (range: 3-199 months). Mean cumulative dose of cabergoline was 279 +/- 301 mg (range: 15-1327 mg). Moderate valve regurgitation was not associated with the duration of treatment (p = 0.359), with cumulative dose of cabergoline (p = 0.173), with age (p = 0.281), with previous treatment with bromocriptine (p = 0.673) or previous adenomectomy (p = 0.497) in patients with HyperPRL.. In conclusion, treatment with cabergoline was not associated with increased prevalence of cardiac valves regurgitation in patients with HyperPRL. Mean cumulative dose of cabergoline was lower in patients with HyperPRL than that reported to be deleterious for patients with Parkinson's disease: hence, longer follow-up is necessary, particularly in patients receiving weekly doses > 3 mg.

Topics: Adult; Aortic Valve Insufficiency; Cabergoline; Case-Control Studies; Dopamine Agonists; Ergolines; Female; Humans; Hyperprolactinemia; Male; Mitral Valve Insufficiency; Risk Factors; Tricuspid Valve Insufficiency

To assess the effect of ergot derivatives on cardiac valves in patients with Parkinson's disease (PD).. Echocardiography was performed on 46 PD patients who used either pergolide or cabergoline (MonoPD) or both (MixPD) for a minimum of 1 year and 49 age-matched healthy controls. Valvular regurgitation was graded as mild, moderate and severe. MonoPD and MixPD groups were compared with regard to demographic features, drug profile and valvulopathy.. The PD group had a mean age of 63 years, agonist duration of 3.8 years and agonist equivalent dose of 3.5mg/day. Moderate regurgitation in all three valves was significantly more common in the PD group than the controls. Severe valvular regurgitation was not observed in either group, with the exception of one PD patient. The frequency of valvulopathy and doses of agonists did not differ between MixPD and MonoPD groups.. PD patients on dopamine ergot agonists are prone to moderate valvular regurgitation more than age-matched controls. However, the frequency of valvulopathy was similar in patients who used either one or more agonists.

Topics: Aged; Antiparkinson Agents; Aortic Valve Insufficiency; Cabergoline; Dopamine Agonists; Drug Therapy, Combination; Echocardiography; Ergolines; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Parkinson Disease; Pergolide; Retrospective Studies; Tricuspid Valve Insufficiency

Used in its neurological indication, cabergoline is known to induce cardiac valve regurgitations, essentially mitral and aortic valvular diseases, by its action on the 5HT2b receptors. Until now, it was assumed that the dose and the duration of exposure were the major factors of appearance. We describe a case of aortic insufficiency which developed in a patient given low doses of cabergoline (0.5 mg weekly) for non-tumoral hyperprolactinemia. Because of previous use of appetite suppressants and of bromocriptine, the exclusive responsibility of cabergoline remained uncertain. The potential gravity of these valvular heart diseases emphasizes the importance of careful cardiologic examination before and during treatment.

Topics: Aortic Valve Insufficiency; Cabergoline; Diagnosis, Differential; Dopamine Agents; Ergolines; Female; Heart Valve Diseases; Humans; Hyperprolactinemia; Middle Aged; Receptor, Serotonin, 5-HT2B