A long-term echocardiographic study of the course of valvular dysfunctions following discontinuation of ergot-derived dopamine agonists in patients with Parkinson's disease

Background An increased risk of restrictive valvular heart disease (VHD) has been widely reported in patients with Parkinson's disease (PD), as a possible consequence of the chronic use of ergot-derived dopamine agonists (EDA), such as pergolide and cabergoline. An aspect that remains poorly investigated is the extent of reversibility of the valvular dysfunction after drug discontinuation. Methods Fifteen patients with PD (8 male and 7 female) on chronic treatment with pergolide or cabergoline in which a cardiac mono or multivalvular fibrosis with or without regurgitation was detected on echocardiographic examination were enrolled in the study from March to December 2007. Because of this the EDA were discontinued and replaced by a non-EDA or l-dopa. A second echocardiography has been performed after a median duration of follow-up of 54 months in order to assess the course of valvular abnormalities i.e. regurgitation, thickening of mitral valve anterior leaflet (MAL) and mitral valve tenting area. Results At the follow-up echocardiographic assessment a complete regression of MAL thickening in 7 out of 13 patients and of the aortic fibrosis in 7 out 10 patients was observed. A statistically significant improvement of mitral and tricuspid valve regurgitation score, sum of regurgitations, thickening of MAL and mitral valve tenting area was found. None of the patients showed a worsening of VHD after drug withdrawal. Conclusions This long-term study confirms an improvement of the restrictive VHD after withdrawal of EDA in PD patients. However, only a partial reversibility of cardiac valvular abnormalities was observed.