Valvular heart disease in Parkinson's disease patients treated with dopamine agonists: A reader-blinded monocenter echocardiography study

Objektive: We evaluated the effects of four ergot or non-ergot dopamine agonists (DAs) on morphology and function of heart valves in patients with Parkinson's disease (PD) to determine the frequency and clinical relevance of valvular heart disease (VHD) associated with both classes of DAs. Aims: Fibrotic VHD has been reported in association with ergot DAs, but the current database is insufficient, particularly regarding clinical relevance and comparison to data on non-ergot DAs. Methods: 85 PD patients treated with ergot DAs (pergolide, n=25; cabergoline, n=24) or with non-ergot DAs (ropinirole, n=13; pramipexole, n=23) for at least 9 months and without any previous exposure to DAs were evaluated by transthoracic echocardiography. Valvular pathology was assessed according to a VHD scoring system and established criteria of valvular regurgitation. Age-matched probands without DA treatment were used as controls. Results: We did not find any case of proven VHD in both patients and controls. 22% of ergot DA patients (5 pergolide, 6 cabergoline) had suggestive VHD or restrictive tricuspid disease (VHD score 2) vs. 3% of non-ergot DA patients and none of controls (P=0.001). We did not find correlations of echocardiographic findings with duration of treatment, cumulative DA dosage, age or vascular risk factors. Standard quantification of valvular regurgitation showed similar results. Conclusions: Our data suggest that treatment with ergot DAs is associated with higher prevalence of suggestive VHD compared to non-ergot DAs and controls, but the risk to develop clinically relevant VHD is low. The clinical consequence of our data are regular physical and echocardiographic surveillance of PD patients before and during treatment with ergot DAs. We recommend the use of standard grading systems to evaluate valvular pathology.