ergoline and Mitral-Valve-Insufficiency

Chronic low-dose cabergoline treatment for microprolactinoma may cause cardiac valve pathology, but the evidence is contradictory. We investigated whether the expectation of the echocardiographer could influence the report.. Transthoracic echocardiograms from 40 patients aged 49·3 ± 9·6 (mean ± SD) years (Men:Women 7:33) on long-term cabergoline and bromocriptine therapy (duration 9·94 ± 4·5 years) were randomly assigned to two groups of echocardiographers so that each echocardiogram was reported twice. One group was told that 'the patients were control subjects' (Group A) and the other that 'the patients were on dopamine agonist therapy which is known to cause valve disease' (Group B). An observer who was blind to the group scored the reports for regurgitation at each valve (scores 0-4; max 16 per case).. Mean total regurgitation score was significantly higher in Group B (1·43 ± 1·28; P = 0·014) than in Group A (0·73 ± 1·30). The difference was mainly from reporting trivial regurgitation: (mitral 16 vs 5, P = 0·005; tricuspid 17 vs 6, P = 0·007 and pulmonary 8 vs 1, P = 0·013). Mild regurgitation was uncommon (mitral 1 vs 1 and tricuspid 3 vs 6). Moderate regurgitation occurred in only one case and was associated with restriction of the leaflets consistent with the effects of cabergoline. Valve thickening was not reported in Group A, but in 9 (23%) mitral and 4 (10%) aortic valves in Group B.. Long-term, low-dose dopamine agonist therapy rarely causes cardiac valve disease, but operator bias can lead to over-reporting of both valve thickening and trivial regurgitation.

Topics: Adult; Antineoplastic Agents; Artifacts; Bias; Cabergoline; Dopamine Agonists; Echocardiography; Ergolines; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Pituitary Neoplasms; Prolactinoma; Tricuspid Valve Insufficiency

Fibrotic valvular heart disease (VHD) has been reported in association with ergot dopamine agonists (DAs), but the current database is insufficient regarding clinical relevance and comparison to data on non-ergot DAs. We evaluated the effects of four DAs (pergolide, cabergoline, ropinirole, pramipexole) on morphology and function of heart valves in patients with Parkinson's disease (PD) to determine the frequency and clinical relevance of DA-induced VHD. A total of 85 patients treated with ergot or non-ergot DAs and 38 age-matched controls were evaluated by transthoracic echocardiography. Valvular pathology was assessed by established criteria of valvular regurgitation and a VHD scoring system. Both grading systems revealed increased frequency of VHD in ergot DA patients compared to both non-ergot DA patients and controls with 22% of ergot DA patients having moderate VHD versus 3% of non-ergot DA patients and none of controls (P = 0.001). We did not find correlations of echocardiographic findings with duration/cumulative dose of treatment, age, or vascular risk factors. Our data suggest that ergot DAs are associated with higher prevalence of VHD compared to non-ergot DAs and controls. Standard echocardiography seems sufficient to detect VHD in PD patients treated with DAs.

Topics: Benzothiazoles; Cabergoline; Dopamine Agonists; Double-Blind Method; Echocardiography; Ergolines; Female; Fibrosis; Heart Valve Diseases; Humans; Hypertrophy, Left Ventricular; Indoles; Male; Middle Aged; Mitral Valve Insufficiency; Parkinson Disease; Pergolide; Pramipexole; Severity of Illness Index; Tricuspid Valve Insufficiency

Bromocriptine and cabergoline, ergot derived dopamine receptor agonists used to treat Parkinson's disease and prolactinomas, have been associated with increased risk of cardiac valve disease. Here we present a case of iatrogenic symptomatic severe mitral regurgitation due to these drugs.

Topics: Antineoplastic Agents; Bromocriptine; Cabergoline; Drug Therapy, Combination; Ergolines; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hormone Antagonists; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Pituitary Neoplasms; Prolactinoma; Treatment Outcome

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

Topics: Brain Ischemia; Cabergoline; Dopamine Agonists; Dose-Response Relationship, Drug; Ergolines; Fatal Outcome; Fibrosis; Heart Valve Prosthesis Implantation; Humans; Intestinal Obstruction; Male; Middle Aged; Mitral Valve Insufficiency; Pituitary Neoplasms; Prolactinoma; Tricuspid Valve Insufficiency; Ventricular Dysfunction, Left

The use of ergoline dopamine agonists for treatment of Parkinson's disease has recently been associated with the development of valvular heart disease. We here report the case of a patient who revealed severe mitral valve regurgitation and refractory cardiogenic shock during treatment with cabergolin in the absence of other causes for valvular disease. To the best of our knowledge, such a rapid progression and ultimately fatal outcome has not been described yet. Our case reemphasizes that patients with long-term administration of ergolines should be closely monitored for valvular degeneration.

Topics: Aged; Cabergoline; Ergolines; Fatal Outcome; Female; Humans; Long-Term Care; Mitral Valve Insufficiency; Shock, Cardiogenic

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

The cardiac valvular risk associated with lower exposure to cabergoline in common endocrine conditions such as hyperprolactinemia is unknown.. We performed a cross-sectional, case-control echocardiographic study to assess the valvular status in 102 subjects receiving cabergoline for endocrine disorders and 51 matched control subjects. Cabergoline treatment ranged from 12 to 228 months, with a cumulative dose of 18-1718 mg. Valvular regurgitation was equally prevalent in both groups and was almost exclusively mild. Two cabergoline-treated subjects had moderate mitral regurgitation; there was no relationship between cabergoline dose and the presence or severity of mitral valve regurgitation (P=NS). Mitral valve tenting area was significantly greater in the cabergoline group when compared with the control subjects (P=0.03). Mitral valve leaflet thickening was observed in 5.9% of cabergoline-treated subjects; no relationship with the cumulative cabergoline dose was found. No patient had aortic or tricuspid valvular restriction.. No significantly increased risk of clinically relevant cardiac valve disorders was found in subjects treated with long-term cabergoline therapy at the doses used in endocrine practice. While exposure to cabergoline appears to be safe during low-dose long-term therapy, an association with subclinical changes in mitral valve geometry cannot be completely excluded.

Topics: Adult; Aged; Cabergoline; Cross-Sectional Studies; Dopamine Agonists; Echocardiography; Endocrine System Diseases; Ergolines; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Risk Factors

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

The case of a restrictive valve disease associated with cabergoline, an ergot alkaloid agonist used in the treatment of Parkinson's disease, is described. Cardiovascular and periodical follow-up assessment may be required when these drugs are prescribed.

Topics: Antiparkinson Agents; Cabergoline; Ergolines; Female; Heart Valve Diseases; Humans; Middle Aged; Mitral Valve Insufficiency

An 82-year-old man was referred to our hospital because of progressive heart failure. He had Parkinson's disease and had been treated with cabergoline during the preceding 4 years and 8 months. Echocardiography revealed severe mitral regurgitation through retracted mitral leaflets with incomplete coaptation. Heart failure persisted despite pharmacologic therapy, so the mitral valve was surgically replaced with a biological valve. Histologic analysis showed fibrous thickened mitral chordae with myxoid degeneration. These characteristics of the mitral valve of our patient are similar to the valvular heart disease described with the use of cabergoline. Clinicians must be care of valvular heart disease whenever they treat Parkinson's disease patients with cabergoline.

Topics: Aged, 80 and over; Antiparkinson Agents; Bioprosthesis; Cabergoline; Chordae Tendineae; Echocardiography; Ergolines; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve; Mitral Valve Insufficiency; Parkinson Disease

Topics: Aged; Cabergoline; Dopamine Agonists; Ergolines; Humans; Hyperprolactinemia; Male; Mitral Valve Insufficiency; Parkinson Disease

Topics: Aged; Antiparkinson Agents; Cabergoline; Dopamine Agonists; Ergolines; Humans; Male; Mitral Valve; Mitral Valve Insufficiency; Parkinson Disease; Ultrasonography