Low incidence of restrictive valvulopathy in patients with Parkinson's disease on moderate dose of pergolide

Abstract

Restrictive valvular heart disease (VHD) has recently been reported in Parkinson's disease (PD) patients treated with ergot dopamine agonists. The aim of the present study was to detect valvular changes in our patients and to investigate their relationship to long-term use of pergolide. We examined 90 patients (mean age 60.8 +/- SD 9.5 years) with PD, average duration 10.0 +/- 5.1 years. Mean pergolide dose was 2.93 +/- 0.75 (range 0.75 to 5) mg per day. 36 subjects (mean age 55.0 +/- 12.8 years) served as controls. All subjects underwent transthoracic echo-Doppler examination. Valve morphology was rated as normal, fibrotic, restrictive, or degenerative. In addition, the mitral tenting area (TA) and tenting distance (TD) were assessed. In 40 out of 90 (45%) PD patients and in 13 out of 36 (36%) controls, mild mitral regurgitation was observed. In 1 PD patient, a moderate mitral regurgitation was recorded. However, no case of restrictive VHD was found. Neither the TA (1.44 +/- 0.24 cm(2) vs 1.33 +/- 0.44 cm(2)) nor the TD (0.73 +/- 0.10 cm vs. 0.72 +/- 0.30 cm) differed from controls. There were no correlations between the current or cumulative dose of pergolide and TA or TD. Discrete fibrotic changes on valves were found in 10 out of 90 (11%) patients. Degenerative changes of valves were found in 11 (12%) patients and in 7 (19 %) controls. Thus in contrast to earlier findings of restrictive VHD in up to one-third of PD patients on pergolide, we did not find any significant heart disease. We only observed mild to moderate mitral regurgitation and clinically insignificant valvular fibrosis. A possible reason for such a discrepancy is that the daily doses of pergolide in our patients were inferior to those reported previously. In conclusion, the prevalence of restrictive VHD has been lower than expected in our patients with PD, probably in relation to moderate daily doses of pergolide.