De Vecchis R, Esposito C, Ariano C
Cardiology Unit , Presidio Sanitario Intermedio"Elena d'Aosta", Via Cagnazzi 29, 80137, Naples, Italy,
Herz. 2013 Dec;38(8):868-80. doi: 10.1007/s00059-013-3816-0. Epub 2013 Jun 8.
Therapy with ergot-derivative dopamine agonists (ergot-DAs) is suspected to cause or promote the development of insufficiency and regurgitation in previously normal cardiac valves. Thus, we conducted a systematic review and meta-analysis of the literature to determine whether administration of cabergoline, i.e., an ergot-DA used to treat Parkinson's disease (PD) or hyperprolactinemia, is associated with an increased risk of valve regurgitation compared with pharmacological regimens not comprising ergot-DAs or with no therapy.
Observational studies were selected from the Pubmed and Embase databases. Studies had to have assessed the prevalence, odds, or risk of cardiac valve regurgitation in patients who underwent chronic treatment with cabergoline for PD or hyperprolactinemia compared with patients with the same diseases whose therapy did not include cabergoline or another ergot-DA. Separate meta-analyses were performed for PD and hyperprolactinemia patients.
On the basis of five studies, 634 PD patients were taking cabergoline, while 9,120 PD patients were treated with dopa/dopamine decarboxylase inhibitor, alone or associated with a non-ergot DA. Valvular regurgitation of any degree - at one cardiac valve or more - was more frequent in PD patients who were taking cabergoline compared to those treated with a non-ergot DA agent or not treated with any dopamine agonist [adjusted (inverse variance: iv) odds ratio: 7.25 95 % CI: 3.71-14.18; p < 0.0001]. On the other hand, pooled data from seven studies showed that patients with hyperprolactinemia who were taking cabergoline (n = 444) exhibited significantly higher odds of mild- to-moderate tricuspid regurgitation compared to untreated controls (n = 954) [adjusted (iv) odds ratio: 1.92 95 % CI:1.34-2.73; p = 0.0003]. No significant differences in mitral or aortic valve regurgitation were detected between hyperprolactinemic patients taking cabergoline and controls.
In PD patients, the risk of valvular regurgitation of any grade involving one or more cardiac valves was proven to be strongly associated with cabergoline treatment. Furthermore, based on our results, hyperprolactinemic patients taking cabergoline have an increased risk of mild-to-moderate tricuspid valve regurgitation.
麦角衍生物多巴胺激动剂（ergot-DAs）治疗被怀疑会导致或促进先前正常心脏瓣膜出现功能不全和反流。因此，我们对文献进行了系统评价和荟萃分析，以确定用于治疗帕金森病（PD）或高泌乳素血症的麦角-DAs（即卡麦角林）与不包含麦角-DAs的药物治疗方案或未治疗相比，是否会增加瓣膜反流风险。
从PubMed和Embase数据库中选取观察性研究。研究必须评估接受卡麦角林长期治疗PD或高泌乳素血症的患者与治疗不包括卡麦角林或其他麦角-DAs的同疾病患者相比，心脏瓣膜反流的患病率、比值或风险。对PD患者和高泌乳素血症患者分别进行荟萃分析。
基于五项研究，634例PD患者服用卡麦角林，而9120例PD患者接受多巴/多巴胺脱羧酶抑制剂单独治疗或与非麦角DA联合治疗。与接受非麦角DA药物治疗或未接受任何多巴胺激动剂治疗的PD患者相比，服用卡麦角林的PD患者出现任何程度（累及一个或多个心脏瓣膜）的瓣膜反流更为常见[校正（逆方差：iv）比值比：7.25，95%CI：3.71-14.18；p<0.0001]。另一方面，来自七项研究的汇总数据显示，与未治疗的对照组（n=954）相比，服用卡麦角林的高泌乳素血症患者（n=444）出现轻度至中度三尖瓣反流的几率显著更高[校正（iv）比值比：1.92，95%CI：1.34-2.73；p=0.0003]。服用卡麦角林的高泌乳素血症患者与对照组在二尖瓣或主动脉瓣反流方面未检测到显著差异。
在PD患者中，已证实涉及一个或多个心脏瓣膜的任何级别的瓣膜反流风险与卡麦角林治疗密切相关。此外，根据我们的结果，服用卡麦角林的高泌乳素血症患者出现轻度至中度三尖瓣反流的风险增加。
