Peralta Cecilia, Wolf Elisabeth, Alber Hannes, Seppi Klaus, Müller Silvana, Bösch Sylvia, Wenning Gregor K, Pachinger Otmar, Poewe Werner
Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
Mov Disord. 2006 Aug;21(8):1109-13. doi: 10.1002/mds.20887.
Restrictive valvulopathy has been reported in association with dopamine agonist therapy in parkinsonian patients. The majority of reports have been related to pergolide, but anecdotal cases following treatment with bromocriptine or cabergoline have also been presented. It is presently unclear whether the potential induction of restrictive cardiac valvulopathy is a class effect of all dopamine agonists or if there is a differential risk between ergot and nonergot compounds. In this study, the frequency of a valvular regurgitation as assessed by routine transthoracic echocardiography was compared between 75 patients with Parkinson's disease (PD) treated with pergolide (n = 29), cabergoline (n = 13), pramipexole or ropinirole (n = 33), and 49 age-matched nonparkinsonian controls. The exposure to pergolide and cabergoline was associated with higher frequencies of valvular regurgitation grades 2 and 3 (31% and 47%) compared with age-matched controls (13%), while there was no increase of valvular regurgitation grades 2 and 3 in patients treated with nonergot compounds (10%). Evidence for restrictive valvulopathy was found in one patient treated with pergolide and cabergoline each. While this study shows similarly increased frequencies of valvular regurgitation in patients treated with the ergot agonists pergolide and cabergoline in comparison to both normal controls and patients treated with nonergot agonists, evidence for restrictive valvulopathy was only found in two cases. These results highlight the need for further prospective studies of the prevalence and underlying mechanisms of cardiac valvulopathy in PD patients treated with different dopamine agonists.
已有报道称，帕金森病患者接受多巴胺激动剂治疗会出现限制性瓣膜病。大多数报道与培高利特有关，但也有使用溴隐亭或卡麦角林治疗后的个别病例。目前尚不清楚潜在诱发的限制性心脏瓣膜病是所有多巴胺激动剂的类效应，还是麦角类和非麦角类化合物之间存在不同风险。在本研究中，比较了75例接受培高利特（n = 29）、卡麦角林（n = 13）、普拉克索或罗匹尼罗（n = 33）治疗的帕金森病（PD）患者与49例年龄匹配的非帕金森病对照者，通过常规经胸超声心动图评估的瓣膜反流频率。与年龄匹配的对照者（13%）相比，接受培高利特和卡麦角林治疗的患者出现2级和3级瓣膜反流的频率更高（分别为31%和47%），而接受非麦角类化合物治疗的患者中2级和3级瓣膜反流并未增加（10%）。分别在1例接受培高利特和1例接受卡麦角林治疗的患者中发现了限制性瓣膜病的证据。虽然本研究显示，与正常对照者和接受非麦角类激动剂治疗的患者相比，接受麦角类激动剂培高利特和卡麦角林治疗的患者瓣膜反流频率同样增加，但仅在2例患者中发现了限制性瓣膜病的证据。这些结果凸显了对接受不同多巴胺激动剂治疗的PD患者心脏瓣膜病的患病率及潜在机制进行进一步前瞻性研究的必要性。
