title: Treatment of Parkinson's disease with pergolide and relation to restrictive valvular heart disease.
abstract: BACKGROUND
  Restrictive valvular heart disease has been reported in patients with Parkinson's disease treated with pergolide. However, few data are available on frequency, severity, dose dependency, and reversibility of pergolide-induced disease, nor on the pulmonary pressures of these patients. We aimed to clarify these characteristics in a large group of patients.
  
  
  METHODS
  78 patients with Parkinson's disease treated with pergolide and 18 never treated with an ergot-derived dopamine agonist (controls) were evaluated by echocardiography. A valvular scoring system was used, ranging from 1 (proven ergot-like restrictive valvular heart disease) to 4 (no disease). For the mitral valve, tenting areas and tenting distances were measured. Systolic pulmonary artery pressures were derived from the tricuspid regurgitant jet.
  
  
  RESULTS
  Restrictive valvular heart disease of any type was present in 26 (33%) patients in the pergolide group and none in controls (p=0.0025). Important disease (score 1 or 2) was present in 15 (19%) patients in the pergolide group and none in controls (p=0.066). Mean tenting distances and tenting areas of the mitral valve were 1.08 cm (range 0.55-2.66) and 2.39 cm2 (0.88-4.59) in the restrictive mitral valve group versus 0.63 cm (0.22-1.20) and 1.39 cm2 (0.39-3.23) in the non-restrictive group (p=0.003 and p<0.0001, respectively). Significant correlation was noted between cumulative doses of pergolide and tenting areas of the mitral valves (r=0.412, p=0.017). Mean systolic pulmonary artery pressures were 39.3 mm Hg (range 25-71) in the high-dose group versus 38.5 mm Hg (20-65) in the low-dose group (p=0.76) and 31 mm Hg (25-40) in controls (p=0.02 vs all patients given pergolide). In six patients, pergolide treatment was stopped because of restrictive valvular heart disease, in two of whom regression of disease was shown.
  
  
  CONCLUSIONS
  Restrictive valvular heart disease is not a rare finding in patients treated with pergolide. Clinicians should consider changing to a non-ergot drug if this disease is diagnosed.
authors.affiliation: Department of Cardiology, AZ VUB, Brussels, Belgium. guy.vancamp@az.vub.ac.be
authors.forename: Guy
authors.initials: G
authors.lastname: Van Camp
authors.forename: Anja
authors.initials: A
authors.lastname: Flamez
authors.forename: Bernard
authors.initials: B
authors.lastname: Cosyns
authors.forename: Caroline
authors.initials: C
authors.lastname: Weytjens
authors.forename: Luc
authors.initials: L
authors.lastname: Muyldermans
authors.forename: Michel
authors.initials: M
authors.lastname: Van Zandijcke
authors.forename: Johan
authors.initials: J
authors.lastname: De Sutter
authors.forename: Patrick
authors.initials: P
authors.lastname: Santens
authors.forename: Pierre
authors.initials: P
authors.lastname: Decoodt
authors.forename: Christian
authors.initials: C
authors.lastname: Moerman
authors.forename: Danny
authors.initials: D
authors.lastname: Schoors
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D004452:Echocardiography; D004873:Ergolines / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006349:Heart Valve Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D010479:Pergolide / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000978:Antiparkinson Agents; D018491:Dopamine Agonists; D004873:Ergolines; D010479:Pergolide