Aortic Valve Calcification and Mild Tricuspid Regurgitation But No Clinical Heart Disease After Eight Years of Dopamine Agonist Therapy for Prolactinoma

Population-based studies have reported an increased incidence and relative risk of cardiac valve disease in patients with Parkinson disease treated with the dopamine agonists, pergolide or cabergoline. It is unclear whether the use of these agents for treatment of prolactinomas is associated with cardiac valve disease. This prospective cross-sectional study assessed the prevalence of valvular heart disease in patients treated with cabergoline for prolactinomas. Standard 2-dimensional and color Doppler echocardiography was performed in 78 consecutive patients with prolactinomas treated for at least 1 year with cabergoline (n = 47) and in 78 untreated controls (n = 31). Mean age of the patients was 47 ± 1.4 year and 74% were women. A macroprolactinoma was present in 31% of the study subjects. Mean duration of treatment was 5.2 ± 0.4 year (range 1–10.3 years). Patients in the cabergoline group were matched with controls for age, gender, body surface, and left ventricular systolic function. The cumulative dose was 363 ± 55 mg (range 24–1768 mg). No difference in the incidence of clinically significant valvular heart disease was found between the cabergoline and the untreated group [12% of patients (9 of 78) compared with 17% of controls (13 of 78), P = 0.141] or between cabergoline and patients receiving other or no dopamine agonist (P = 0.062). The prevalence of mild tricuspid regurgitation was significantly higher in patients compared with controls (41% vs. 26%, P < 0.042). Aortic valve calcification was also higher (40% vs. 18%, P < 0.003). No correlation was found between the cumulative dose of cabergoline and the presence of mild, moderate, or severe valve regurgitation. These findings demonstrate that several years of treatment with a dopamine agonist in patients with prolactinomas is not associated with increased prevalence of clinically relevant valvular heart disease.