Valvular heart disease in patients exposed to pergolide: insights from the clinical presentation.
OBJECTIVE
The aim of this study was to determine whether the presence of symptoms would aid in the detection of valvular heart disease (VHD) in those exposed to pergolide.


METHODS
Utilizing a prospective, cross-sectional study design, patients with an exposure to pergolide were asked regarding the presence or absence of chest pain, shortness of breath or lower extremity edema through a questionnaire. Echocardiograms were obtained on the same day as the questionnaire and were blinded to all staff involved in the study. The sensitivity, specificity, positive and negative predictive value of the reported symptoms towards the outcome moderate or severe valvular regurgitation were obtained. Using the area under the receiver-operating characteristic curve, we also ascertained whether a relationship existed between symptoms, pergolide dose and presence of VHD. To understand the associations between symptoms and echocardiographic covariates, a logistic regression analysis was performed adjusted for age and gender.


RESULTS
The sensitivity, specificity, positive and negative predictive value of symptom presentation and total dose was sufficiently low that it did not aid in the determination whether significant valvular regurgitation was present. Multivariable analysis noted a significant association with indexed left atrial volume (p = 0.011), estimated pulmonary artery pressure (p = 0.047) and shortness of breath.


CONCLUSIONS
The presence or absence of symptoms does not help guide whether valvular regurgitation is present or absent in individuals exposed to pergolide. Therefore, echocardiography is needed to confirm or refute pergolide-associated VHD.
Division of Cardiology, Kaiser Permanente, San Jose, California, USA. ashok.krishnaswami@kp.org
Ashok
A
Krishnaswami
Kathleen B
KB
Albers
Robin D
RD
Fross
James J
JJ
Jang
Sarah B
SB
Berkheimer
Valerie C
VC
Kwai Ben
Stephen K
SK
Vandeneeden
D000368:Aged; D002140:California; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000139:chemically induced* / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010479:Pergolide / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors
D018491:Dopamine Agonists; D010479:Pergolide