Herring Neil, Szmigielski Cezary, Becher Harald, Karavitaki Niki, Wass John A H
Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford University, Oxford, UK.
Clin Endocrinol (Oxf). 2009 Jan;70(1):104-8. doi: 10.1111/j.1365-2265.2008.03458.x.
The use of high doses of the ergot-derived dopamine agonist cabergoline (> 3 mg/day), especially with cumulative doses > 4000 mg, has been associated with an increase in cardiac valvular thickening and significant (moderate to severe) regurgitation. Whether lower doses commonly used in the treatment of prolactinomas (0.25-3 mg/week) are also associated with significant valvulopathy is controversial. The mitral valve tenting area, a subclinical index of leaflet stiffening, has also been correlated with the cumulative dose of cabergoline and severity of valvular regurgitation.
DESIGN/PATIENTS/MEASUREMENTS: We performed transthoracic echocardiography (TTE) on 50 prolactinoma patients (48% macroprolactinomas, 52% microprolactinomas, 30 male, 20 female, age 51.2 +/- 2.2 years, mean +/- SEM) who had been taking cabergoline for 6.6 +/- 0.5 years (range 1-13 years) with cumulative doses of 443 +/- 53 mg, to determine the prevalence of significant valvular thickening (> 0.5 cm) and regurgitation, and measured the mitral valve tenting area and height. The results were compared to those from age- and sex-matched controls with normal left ventricular function.
No significant valvular thickening or regurgitation of any valve was detected in the prolactinoma group and the prevalence of mild valvular regurgitation was not higher than in the case-control group. The mitral valve tenting area and height were not significantly greater than in the control group. There was no correlation between tenting area or height and cumulative cabergoline dose.
We found no evidence of increased mitral valve tenting area/height, valvular thickening or significant regurgitation with the long-term administration of the commonly used doses of cabergoline to treat prolactinoma.
使用高剂量麦角衍生的多巴胺激动剂卡麦角林（>3毫克/天），尤其是累积剂量>4000毫克时，已被发现与心脏瓣膜增厚增加及显著（中度至重度）反流有关。治疗泌乳素瘤常用的较低剂量（0.25 - 3毫克/周）是否也与显著的瓣膜病相关存在争议。二尖瓣帐篷面积是瓣叶僵硬的亚临床指标，也与卡麦角林的累积剂量及瓣膜反流的严重程度相关。
设计/患者/测量：我们对50例泌乳素瘤患者（48%为大泌乳素瘤，52%为微泌乳素瘤，男性30例，女性20例，年龄51.2±2.2岁，均值±标准误）进行了经胸超声心动图（TTE）检查，这些患者服用卡麦角林6.6±0.5年（范围1 - 13年），累积剂量为443±53毫克，以确定显著瓣膜增厚（>0.5厘米）和反流的患病率，并测量二尖瓣帐篷面积和高度。将结果与年龄和性别匹配、左心室功能正常的对照组进行比较。
泌乳素瘤组未检测到任何瓣膜有显著增厚或反流，轻度瓣膜反流的患病率不高于病例对照组。二尖瓣帐篷面积和高度与对照组相比无显著差异。帐篷面积或高度与卡麦角林累积剂量之间无相关性。
我们发现，长期使用治疗泌乳素瘤的常用剂量卡麦角林，没有证据表明二尖瓣帐篷面积/高度增加、瓣膜增厚或显著反流。
