Gamble David, Fairley Rachel, Harvey Roderick, Farman Colin, Cantley Nathan, Leslie Stephen J
University of Aberdeen, Aberdeen Royal Infirmary, NHS Grampian, Foresterhill, Aberdeen, UK.
NHS Highland Medicine Information, Pharmacy Department, Raigmore Hospital, Inverness, UK.
Ther Adv Drug Saf. 2017 Jul;8(7):215-229. doi: 10.1177/2042098617703647. Epub 2017 Apr 25.
The indication for screening for valvular heart disease in patients taking cabergoline is based on evidence from patients with Parkinson's disease on high-dose medication. However, current patients take much lower doses for indications such as hyperprolactinaemia disorders. Contemporary guidelines for echocardiogram monitoring in patients taking cabergoline are conflicting. This study aimed to review current clinical practice in our area regarding echocardiographic screening and to review the literature examining the evidence of valvular heart disease in patients taking lower dose cabergoline.
This was a retrospective study of all patients with hyperprolactinaemia disorders prescribed cabergoline in a single UK NHS health board between January 2014 and July 2015. The proportion of patients receiving baseline and follow-up echocardiograms was recorded. A review of the published literature was carried out using the databases EMBASE and Medline to examine the current evidence for the effect cabergoline has on cardiac valves in patients treated for hyperprolactinaemia disorders.
The mean age was 51.7 ± 16.5 years with a 64.4% female predominance. The mean duration of therapy was 5.9 years ± 4.1 years. Of the total cohort ( = 45), two (4.4%) patients had an initial baseline echocardiogram and five (13.2%) had follow-up echocardiograms every 24 months. Of the 25 articles identified, 12 showed no clinically significant evidence of valvular dysfunction in the cabergoline group groups. Of the remaining 13 articles, evidence for valvular changes was confined to high cumulative dose cabergoline patients and there was only one confirmed case of 'cabergoline associated valvulopathy' described.
Clinically significant valvular dysfunction is uncommon and generally only reported in high cumulative dose treatment groups. We propose that clearer national guidelines are required and that echocardiogram screening be reserved for patients who are high risk, are taking a high weekly dose (≥2 mg cabergoline weekly) or high cumulative dose.
对服用卡麦角林的患者进行心脏瓣膜病筛查的指征是基于帕金森病患者高剂量用药的证据。然而，目前患者因高泌乳素血症等病症服用的剂量要低得多。关于服用卡麦角林患者的超声心动图监测的当代指南存在冲突。本研究旨在回顾我们地区当前关于超声心动图筛查的临床实践，并回顾研究服用低剂量卡麦角林患者心脏瓣膜病证据的文献。
这是一项对2014年1月至2015年7月期间在英国单一国民保健服务（NHS）健康委员会中所有因高泌乳素血症病症而开具卡麦角林处方的患者的回顾性研究。记录接受基线和随访超声心动图检查的患者比例。使用EMBASE和Medline数据库对已发表的文献进行综述，以研究卡麦角林对接受高泌乳素血症病症治疗患者心脏瓣膜影响的当前证据。
平均年龄为51.7±16.5岁，女性占主导，比例为64.4%。平均治疗时长为5.9年±4.1年。在整个队列（n = 45）中，两名（4.4%）患者进行了初始基线超声心动图检查，五名（13.2%）患者每24个月进行一次随访超声心动图检查。在确定的25篇文章中，12篇显示卡麦角林组没有临床上显著的瓣膜功能障碍证据。在其余13篇文章中，瓣膜变化的证据仅限于高累积剂量卡麦角林患者，且仅描述了一例确诊的“卡麦角林相关性瓣膜病”病例。
临床上显著的瓣膜功能障碍并不常见，通常仅在高累积剂量治疗组中报道。我们建议需要更明确的国家指南，并且超声心动图筛查应保留给高危患者、每周服用高剂量（≥2mg卡麦角林每周）或高累积剂量的患者。
