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Heart valve disease associated with treatment with ergot‐derived dopamine agonists: a clinical and echocardiographic study of patients with Parkinson’s disease
Author(s) -
Rasmussen V. G.,
Poulsen S. H.,
Dupont E.,
Østergaard K.,
Safikhany G.,
Egeblad H.
Publication year - 2008
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.2007.01874.x
Subject(s) - medicine , valvular heart disease , cardiology , regurgitation (circulation) , mitral valve prolapse , mitral regurgitation , heart disease , mitral valve , heart failure , cohort
. Objective. To elucidate the association between treatment with ergot‐derived dopamine agonists (EDDA) and valvular abnormalities amongst patients with idiopathic Parkinson’s disease (IPD) and secondly, to analyse the yield of clinical screening for valvular heart disease. Design. A cross‐sectional controlled study. Setting. The cohort of IPD patients treated in the outpatient clinic, Department of Neurology, Aarhus University Hospital, Denmark. Subjects. A total of 138 IPD patients [median age 64 (39–87) years, 62% men] treated with either EDDA ( n = 85) or non‐EDDA ( n = 53) for at least 6 months. Interventions. Patients were screened for valvular heart disease by clinical means and by examiner‐blinded echocardiography. Main outcome measure was valvular regurgitation revealed by echocardiography. Results. Severe aortic regurgitation ( n = 4) or moderate aortic ( n = 12), mitral ( n = 3) or tricuspidal valve regurgitation ( n = 5) was found in 22 EDDA patients (25.9%). Two patients had coexistent moderate mitral and tricuspid valvular regurgitation. Two non‐EDDA patients had moderate valve insufficiency (3.8%, P < 0.05). The adjusted relative risk for at least moderate valve insufficiency in the EDDA patients was 7.2% ( P < 0.05). The sensitivity of detecting at least moderate valvular disease by cardiac murmur, dyspnoea, or the heart failure marker NT‐proBNP (natriuretic peptide) was 62% for the neurologists and 93% for the cardiologist but with equally low specificity (30–35%). Conclusion. EDDA was associated with a clinically important and statistically significant risk of at least moderate valve regurgitation. Clinical screening for valve disease was inadequate and it seems advisable to offer EDDA patients control with echocardiography.