Changes in heart valve structure and function in patients treated with dopamine agonists for prolactinomas, a 2-year follow-up study.
OBJECTIVE
The use of ergot-derived dopamine agonists (DA) to treat patients with prolactinomas has not been associated with an increased risk of significant heart valve dysfunction. Accordingly, the present study evaluated whether the long-term use of DA for hyperprolactinaemia may be associated with increased risk of significant valvular heart disease.


METHODS
A total of 74 patients (mean age 48 ± 1·4 years, 23% male) with prolactinoma treated with DA for at least 1 year were evaluated with 2-dimensional echocardiography at baseline. After 2 years of follow-up, a repeat echocardiography was performed to evaluate significant changes in valvular heart structure (thickening, calcifications and leaflet motion abnormalities) and function (regurgitation or stenosis). Patients were classified according to treatment: patients treated with cabergoline (group 1: n = 45), and patients not treated with cabergoline (group 2: n = 29).


RESULTS
At 2-year follow-up, no significant valvular stenosis was observed in any patient. In addition, the prevalence of any significant valve regurgitation did not change significantly (from 12% to 15%, P = NS). However, there was a significant increase in the prevalence of valvular calcifications (from 48% to 58%, P = 0·004) and, particularly, in the prevalence of aortic valve calcifications (from 39% to 53%, P = 0·002). In a per-treatment-based analysis, the group of patients treated with cabergoline had significantly higher prevalence of aortic valve calcification at 2 years follow-up as compared to the group of patients not treated with cabergoline (63%vs 38%, P = 0·016).


CONCLUSIONS
The long-term therapy with DA (cabergoline) of patients with prolactinoma is associated with an increased prevalence of valvular calcification. However, these structural changes were not accompanied by an increased prevalence of valvular dysfunction.
Department of Cardiology Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.
Victoria
V
Delgado
Nienke R
NR
Biermasz
Sjoerd W
SW
van Thiel
See H
SH
Ewe
Nina Ajmone
NA
Marsan
Eduard R
ER
Holman
Richard A
RA
Feelders
Johannes W A
JW
Smit
Jeroen J
JJ
Bax
Alberto M
AM
Pereira
D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000009:adverse effects* / Q000627:therapeutic use*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006351:Heart Valves / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology / Q000648:ultrastructure; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology; D015995:Prevalence; D015175:Prolactinoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology; D013997:Time Factors
D018931:Antineoplastic Agents, Hormonal; D018491:Dopamine Agonists