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Cardiac Valvulopathy Associated with Pergolide Use

  • Cindy Zadikoff (a1), Paula Rochon (a2) and Anthony Lang (a1)

Abstract

Objective:

To review the risk of pergolide associated cardiac valvulopathy in patients with Parkinson's disease.

Data Sources:

MEDLINE, Embase, and the Cochrane Library. Reference lists were reviewed and librarians were consulted to identify additional trials.

Study selection:

All studies and case reports in the English literature on pergolide and cardiac valvulopathy.

Data extraction:

Demographics of patients, study duration, dose and duration of pergolide use, echocardiogram results, length of follow-up, and clinical outcome.

Results:

Twenty-two published articles were identified. There were no randomized controlled trials. Follow-up time varied between a few months and four years. Three case reports and four studies (three case control and one observational) assessed 246 patients. Evidence for valvulopathy was found in all studies. Variable methods were used to assess the degree of valvular regurgitation making comparisons between studies difficult. Little clinical correlation is available for echocardiogram results. Variable improvement was shown in the few patients in whom the drug was stopped. There is insufficient data to determine whether dose and duration or other comorbities have an effect on the risk of developing cardiac valvulopathy.

Conclusion:

Pergolide therapy is associated with an increased risk of developing cardiac valvulopathy but the true incidence and importance of this remains unknown. Further prospective studies are needed with standardized assessments of echocardiograms.

RÉSUMÉ Objectif:

Revoir le risque de valvulopathie cardiaque associée au pergolide chez les patients atteints de la maladie de Parkinson.

Source des données:

MEDLINE, Embase et The Cochrane Library. Nous avons aussi révisé des listes de références et nous avons consulté des bibliothécaires afin d'identifier des études additionnelles.

Sélection des études:

Toutes les études et les rapports de cas de la littérature en anglais sur le pergolide et la valvulopathie cardiaque.

Extraction des données:

Les données démographiques des patients, la durée des études, la dose et la durée d'utilisation du pergolide, les résultats d'échocardiographie, la durée du suivi et l'issue clinique.

Résultats:

Aucun essai randomisé et contrôlé ne figurait parmi les vingt-deux articles identifiés. La durée du suivi était de quelques mois à quatre ans. Trois rapports de cas et quatre études (trois études contrôlées et une étude d'observation) comportaient au total 246 patients évalués. Dans toutes les études, on a rapporté des observations relatives à la valvulopathie. Différentes méthodes ont été utilisées pour évaluer le degré de régurgitation valvulaire, ce qui rend difficile la comparaison entre les études. Il y a peu de données cliniques pour établir une corrélation avec les résultats d'échocardiographie. Chez les quelques patients chez qui on a cessé la médication, on a observé un degré variable d'amélioration. Il n'existe pas suffisamment de données pour déterminer si la dose et la durée d'administration ou d'autres comorbidités ont un effet sur le risque de développer une valvulopathie cardiaque.

Conclusion:

Le traitement par le pergolide comporte un risque accru de développer une valvulopathie cardiaque, mais sa véritable incidence et son importance demeurent inconnues. La standardisation de l'évaluation de l'échocardiogramme devra faire l'objet d'études prospectives.

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Copyright

Corresponding author

Gloria Shulman Movement Disorders Center, Toronto Western Hospital, 399 Bathurst Street, 7-McL, Toronto, Ontario, M5T 2S8, Canada.

References

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Cardiac Valvulopathy Associated with Pergolide Use

  • Cindy Zadikoff (a1), Paula Rochon (a2) and Anthony Lang (a1)

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