Heart valve disease associated with treatment with ergot-derived dopamine agonists: a clinical and echocardiographic study of patients with Parkinson's disease.

Abstract

OBJECTIVE:

To elucidate the association between treatment with ergot-derived dopamine agonists (EDDA) and valvular abnormalities amongst patients with idiopathic Parkinson's disease (IPD) and secondly, to analyse the yield of clinical screening for valvular heart disease.

DESIGN:

A cross-sectional controlled study.

SETTING:

The cohort of IPD patients treated in the outpatient clinic, Department of Neurology, Aarhus University Hospital, Denmark.

SUBJECTS:

A total of 138 IPD patients [median age 64 (39-87) years, 62% men] treated with either EDDA (n = 85) or non-EDDA (n = 53) for at least 6 months. Interventions. Patients were screened for valvular heart disease by clinical means and by examiner-blinded echocardiography. Main outcome measure was valvular regurgitation revealed by echocardiography.

RESULTS:

Severe aortic regurgitation (n = 4) or moderate aortic (n = 12), mitral (n = 3) or tricuspidal valve regurgitation (n = 5) was found in 22 EDDA patients (25.9%). Two patients had coexistent moderate mitral and tricuspid valvular regurgitation. Two non-EDDA patients had moderate valve insufficiency (3.8%, P < 0.05). The adjusted relative risk for at least moderate valve insufficiency in the EDDA patients was 7.2% (P < 0.05). The sensitivity of detecting at least moderate valvular disease by cardiac murmur, dyspnoea, or the heart failure marker NT-proBNP (natriuretic peptide) was 62% for the neurologists and 93% for the cardiologist but with equally low specificity (30-35%).

CONCLUSION:

EDDA was associated with a clinically important and statistically significant risk of at least moderate valve regurgitation. Clinical screening for valve disease was inadequate and it seems advisable to offer EDDA patients control with echocardiography.

• Authors: V G Rasmussen, S H Poulsen, E Dupont, K Østergaard, G Safikhany, H Egeblad
• Journal: Journal of internal medicine (J Intern Med) Vol. 263 Issue 1 Pg. 90-8 (Jan 2008) ISSN: 1365-2796 [Electronic] England
• PMID: 18036161 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Dopamine Agonists
• Ergolines
• Ergot Alkaloids
• Cabergoline

Topics

• Adult
• Aged
• Aged, 80 and over
• Ambulatory Care Facilities
• Cabergoline
• Cross-Sectional Studies
• Denmark
• Dopamine Agonists (adverse effects, therapeutic use)
• Electrocardiography
• Ergolines (adverse effects, therapeutic use)
• Ergot Alkaloids (adverse effects, therapeutic use)
• Female
• Heart Valve Diseases (chemically induced, diagnostic imaging)
• Humans
• Logistic Models
• Male
• Middle Aged
• Parkinson Disease (classification, drug therapy)
• Severity of Illness Index
• Ultrasonography