帕金森病患者停用或继续使用麦角衍生的多巴胺激动剂后的心脏异常：一项治疗盲法超声心动图研究。

Heart abnormalities in Parkinson patients after discontinuation or continuation of ergot-derived dopamine agonists: a treatment-blinded echocardiographic study.

作者信息

Rasmussen Vibeke G, Poulsen Steen H, Dupont Erik, Østergaard Karen, Safikhany Gholamhossein, Egeblad Henrik

机构信息

Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.

出版信息

J Heart Valve Dis. 2009 Jul;18(4):463-9.

PMID:19852154

Abstract

BACKGROUND AND AIM OF THE STUDY

Ergot-derived dopamine agonists (DAs) are used in the treatment of Parkinson's disease, but may be associated with valvular heart disease and pulmonary hypertension. The study aim was to examine changes in cardiovascular abnormalities after the discontinuation or continuation of anti-parkinson treatment.

METHODS

Parkinson patients treated with either ergot-derived (n = 32) or non-ergot-derived (n = 8) DAs who had been diagnosed with valvular abnormalities or pulmonary hypertension, were included in this one-year follow up study. After an initial echocardiography, five patients continued ergot-derived DA treatment, while the remaining 35 either changed (n = 27) or continued (n = 8) non-ergot-derived DA treatment. The patients were followed up after a mean of 14 months (range: 12-18 months). Changes in the severity of valve disease and pulmonary hypertension were evaluated by an analysis of digitally stored echocardiograms. The recordings were performed blinded to medical treatment, while the analyses were blinded to both the medical treatment and the timing of image acquisition.

RESULTS

Follow up revealed the risk of worsening cardiovascular abnormalities to be 60% in patients who continued ergot-derived DA treatment, compared to 14% in those who changed to, or continued with, non-ergot-derived DA medication (p < 0.05). Overall, patients who changed from ergot-derived to non-ergot-derived DAs did not exhibit any significant worsening or improvement of their valve abnormality, although the pulmonary artery pressure (PAP) fell from 26 +/- 12 mmHg to 22 +/- 8 mmHg at follow up (p < 0.005).

CONCLUSION

At one year after discontinuation of ergot-derived DAs, a mild but statistically significant reduction in PAP was detected. Overall, valvular regurgitation remained without definite worsening or improvement in these patients. Among patients who continued ergot-derived DAs despite a cardiovascular abnormality, the follow-up indicated an increased risk of worsening.

摘要

研究背景与目的

麦角衍生的多巴胺激动剂（DAs）用于治疗帕金森病，但可能与心脏瓣膜病和肺动脉高压有关。本研究的目的是探讨停止或继续抗帕金森治疗后心血管异常的变化。

方法

本项为期一年的随访研究纳入了接受麦角衍生（n = 32）或非麦角衍生（n = 8）多巴胺激动剂治疗且已被诊断患有瓣膜异常或肺动脉高压的帕金森病患者。在首次超声心动图检查后，5例患者继续使用麦角衍生的多巴胺激动剂治疗，其余35例患者则更换（n = 27）或继续（n = 8）使用非麦角衍生的多巴胺激动剂治疗。患者平均随访14个月（范围：12 - 18个月）。通过分析数字存储的超声心动图评估瓣膜病和肺动脉高压严重程度的变化。记录过程对治疗情况保密，而分析过程对治疗情况和图像采集时间均保密。

结果

随访发现，继续使用麦角衍生的多巴胺激动剂治疗的患者心血管异常恶化风险为60%，而更换为或继续使用非麦角衍生的多巴胺激动剂治疗的患者这一风险为14%（p < 0.05）。总体而言，从麦角衍生的多巴胺激动剂更换为非麦角衍生的多巴胺激动剂的患者，其瓣膜异常没有出现明显恶化或改善，尽管随访时肺动脉压（PAP）从26 ± 12 mmHg降至22 ± 8 mmHg（p < 0.005）。