Echocardiography in patients with hyperprolactinaemia treated with dopamine agonists. What happens in daily clinical practice and what are the findings?

Abstract

Ergot-derived dopamine agonist therapy (EDDAT) is associated with cardiac valvulopathy in Parkinson's disease. The risk to patients with hyperprolactinaemia is uncertain and there are some discrepancies between studies about the exact nature of cardiac pathology among patients on long-term EDDAT for prolactinoma. The European Medicines Agency (EMEA) and UK Medicines and Health products Regulatory Agency (MHRA) recently issued guidelines for surveillance echocardiography (ECHO) of patients receiving EDDAT. Our policy is to arrange opportunistic ECHO screening at first clinic visit. We investigated the uptake and findings of echocardiography in this cohort. From our endocrine database, we identified patients with hyperprolactinaemia receiving treatment with bromocriptine or cabergoline who attended between 1 July 2008 and 31 October 2009. We audited their treatment, ECHO requests, ECHO findings and the communication of results to the GP. Echocardiography had been requested for 73 (54%) patients. 55 (75%) ECHOs had been performed at UCLH whereas 18 (25%) ECHOS were still pending or had been done at a local hospital. Results were communicated to the GP in 28 (51%) of patients. ECHO was normal in 40 patients (73%). 14 patients (25%) had trivial/mild regurgitation of at least one valve of which 8 patients had mild tricuspid regurgitation, 11 patients had mild mitral regurgitation, 1 patient had mild pulmonary regurgitation and 4 patients had minimal valve leaflet thickening. One patient (2%) had moderate mitral regurgitation.