Department of Cardiology Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.
Clin Endocrinol (Oxf). 2012 Jul;77(1):99-105. doi: 10.1111/j.1365-2265.2011.04326.x.
The use of ergot-derived dopamine agonists (DA) to treat patients with prolactinomas has not been associated with an increased risk of significant heart valve dysfunction. Accordingly, the present study evaluated whether the long-term use of DA for hyperprolactinaemia may be associated with increased risk of significant valvular heart disease.
A total of 74 patients (mean age 48 ± 1·4 years, 23% male) with prolactinoma treated with DA for at least 1 year were evaluated with 2-dimensional echocardiography at baseline. After 2 years of follow-up, a repeat echocardiography was performed to evaluate significant changes in valvular heart structure (thickening, calcifications and leaflet motion abnormalities) and function (regurgitation or stenosis). Patients were classified according to treatment: patients treated with cabergoline (group 1: n = 45), and patients not treated with cabergoline (group 2: n = 29).
At 2-year follow-up, no significant valvular stenosis was observed in any patient. In addition, the prevalence of any significant valve regurgitation did not change significantly (from 12% to 15%, P = NS). However, there was a significant increase in the prevalence of valvular calcifications (from 48% to 58%, P = 0·004) and, particularly, in the prevalence of aortic valve calcifications (from 39% to 53%, P = 0·002). In a per-treatment-based analysis, the group of patients treated with cabergoline had significantly higher prevalence of aortic valve calcification at 2 years follow-up as compared to the group of patients not treated with cabergoline (63%vs 38%, P = 0·016).
The long-term therapy with DA (cabergoline) of patients with prolactinoma is associated with an increased prevalence of valvular calcification. However, these structural changes were not accompanied by an increased prevalence of valvular dysfunction.
使用麦角衍生的多巴胺激动剂（DA）治疗催乳素瘤患者不会增加发生严重心脏瓣膜功能障碍的风险。因此，本研究评估了长期使用 DA 治疗高催乳素血症是否会增加发生严重瓣膜性心脏病的风险。
对至少接受 DA 治疗 1 年的 74 例催乳素瘤患者（平均年龄 48±1·4 岁，23%为男性）进行二维超声心动图评估。随访 2 年后，再次进行超声心动图检查以评估瓣膜心脏结构（增厚、钙化和瓣叶运动异常）和功能（反流或狭窄）的显著变化。根据治疗方法对患者进行分类：接受卡麦角林治疗的患者（组 1：n=45）和未接受卡麦角林治疗的患者（组 2：n=29）。
在 2 年的随访中，未观察到任何患者出现严重瓣膜狭窄。此外，任何严重瓣膜反流的发生率没有显著变化（从 12%变为 15%，P=NS）。然而，瓣膜钙化的发生率显著增加（从 48%变为 58%，P=0·004），尤其是主动脉瓣钙化的发生率显著增加（从 39%变为 53%，P=0·002）。基于治疗的分析中，与未接受卡麦角林治疗的患者相比，接受卡麦角林治疗的患者在 2 年随访时主动脉瓣钙化的发生率明显更高（63%比 38%，P=0·016）。
长期用 DA（卡麦角林）治疗催乳素瘤患者与瓣膜钙化的发生率增加有关。然而，这些结构变化并没有伴随着瓣膜功能障碍发生率的增加。
