Heart abnormalities in Parkinson patients after discontinuation or continuation of ergot-derived dopamine agonists: a treatment-blinded echocardiographic study.
OBJECTIVE
Ergot-derived dopamine agonists (DAs) are used in the treatment of Parkinson's disease, but may be associated with valvular heart disease and pulmonary hypertension. The study aim was to examine changes in cardiovascular abnormalities after the discontinuation or continuation of anti-parkinson treatment.


METHODS
Parkinson patients treated with either ergot-derived (n = 32) or non-ergot-derived (n = 8) DAs who had been diagnosed with valvular abnormalities or pulmonary hypertension, were included in this one-year follow up study. After an initial echocardiography, five patients continued ergot-derived DA treatment, while the remaining 35 either changed (n = 27) or continued (n = 8) non-ergot-derived DA treatment. The patients were followed up after a mean of 14 months (range: 12-18 months). Changes in the severity of valve disease and pulmonary hypertension were evaluated by an analysis of digitally stored echocardiograms. The recordings were performed blinded to medical treatment, while the analyses were blinded to both the medical treatment and the timing of image acquisition.


RESULTS
Follow up revealed the risk of worsening cardiovascular abnormalities to be 60% in patients who continued ergot-derived DA treatment, compared to 14% in those who changed to, or continued with, non-ergot-derived DA medication (p < 0.05). Overall, patients who changed from ergot-derived to non-ergot-derived DAs did not exhibit any significant worsening or improvement of their valve abnormality, although the pulmonary artery pressure (PAP) fell from 26 +/- 12 mmHg to 22 +/- 8 mmHg at follow up (p < 0.005).


CONCLUSIONS
At one year after discontinuation of ergot-derived DAs, a mild but statistically significant reduction in PAP was detected. Overall, valvular regurgitation remained without definite worsening or improvement in these patients. Among patients who continued ergot-derived DAs despite a cardiovascular abnormality, the follow-up indicated an increased risk of worsening.
Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark. vibeke.guldbrand@ki.au.dk
Vibeke G
VG
Rasmussen
Steen H
SH
Poulsen
Erik
E
Dupont
Karen
K
Østergaard
Gholamhossein
G
Safikhany
Henrik
H
Egeblad
D000368:Aged; D018491:Dopamine Agonists / Q000009:adverse effects*; D004876:Ergot Alkaloids / Q000009:adverse effects*; D005260:Female; D006349:Heart Valve Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology; D014463:Ultrasonography
D018491:Dopamine Agonists; D004876:Ergot Alkaloids