Valvular Heart Disease and the Use of Dopamine Agonists for Parkinson's Disease

• Published in: The New England journal of medicine Vol. 356; no. 1; pp. 39 - 46
• Main Authors: Zanettini, Renzo, Antonini, Angelo, Gatto, Gemma, Gentile, Rosa, Tesei, Silvana, Pezzoli, Gianni
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 04.01.2007
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Case-Control Studies; Dopamine Agonists - adverse effects; Drugs; Endocardial and cardiac valvular diseases; Ergolines - adverse effects; Female; General aspects; Heart; Heart Valve Diseases - chemically induced; Heart Valve Diseases - diagnostic imaging; Hospitals; Humans; Informed consent; Male; Medical sciences; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - pathology; Parkinson Disease - complications; Parkinson Disease - diagnostic imaging; Parkinson Disease - drug therapy; Parkinson's disease; Pergolide - adverse effects; Regression Analysis; Risk; Serotonin 5-HT2 Receptor Agonists; Serotonin Receptor Agonists - adverse effects; Ultrasonography; Veins & arteries; Heart; Nervous system diseases; Use; Parkinson disease; Cardiovascular disease; Cerebral disorder; Medicine; Cardiac valvular disease; Central nervous system disease; Dopamine agonist; Complication; Degenerative disease; Extrapyramidal syndrome
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa054830

A cohort of patients with Parkinson's disease treated with either ergot-derived or non–ergot-derived dopamine agonists underwent echocardiographic evaluation. As compared with a group of normal control subjects, patients taking pergolide or cabergoline had a higher frequency of clinically important valve regurgitation and more evidence of stiffening and displacement of the mitral leaflet, as measured by the tenting area of the mitral valve. Patients with Parkinson's disease taking pergolide or cabergoline had a higher frequency of clinically important valve regurgitation and more evidence of stiffening and displacement of the mitral leaflet than controls. Several studies and case reports strongly support a causal relationship between the occurrence of drug-induced “restrictive” valvular heart disease and treatment with pergolide, an ergot-derived dopamine receptor agonist mainly used to treat Parkinson's disease. 1 – 6 More specifically, pergolide may induce fibrotic changes in valve leaflets and in the mitral subvalvular apparatus, causing thickening, retraction, and stiffening of valves and resulting in incomplete leaflet coaptation and valve regurgitation. Valvular heart damage has also been reported with the ergot-derived dopamine agonists bromocriptine and cabergoline. 5 – 7 This is important, since cabergoline is widely prescribed in many countries for Parkinson's disease and, at low . . .