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


METHODS
A cross-sectional controlled study.


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


METHODS
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%).


CONCLUSIONS
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.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. vibeke.guldbrand@ki.au.dk
V G
VG
Rasmussen
S H
SH
Poulsen
E
E
Dupont
K
K
Østergaard
G
G
Safikhany
H
H
Egeblad
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D000077465:Cabergoline; D003430:Cross-Sectional Studies; D003718:Denmark; D018491:Dopamine Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D004562:Electrocardiography; D004873:Ergolines / Q000009:adverse effects / Q000627:therapeutic use; D004876:Ergot Alkaloids / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006349:Heart Valve Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000145:classification / Q000188:drug therapy*; D012720:Severity of Illness Index; D014463:Ultrasonography
D018491:Dopamine Agonists; D004873:Ergolines; D004876:Ergot Alkaloids; D000077465:Cabergoline