Increased prevalence of tricuspid regurgitation in patients with Prolactinomas chronically treated with cabergoline
Increased prevalence of tricuspid regurgitation in patients with Prolactinomas chronically treated with cabergoline
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DOI：
10.1210/jc.2007-1403
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发表时间：
2008-10-01
影响因子：
5.8
通讯作者：
Lombardi, Gaetano
中科院分区：
文献类型：
--
作者：
Colao, Annamaria;Galderisi, Maurizio;Lombardi, Gaetano
背景资料：卡麦角林是一种用于治疗泌乳素瘤的多巴胺受体2激动剂，与帕金森病患者心脏瓣膜疾病风险增加相关。目的：我们的目的是评估卡麦角林治疗泌乳素瘤患者心脏瓣膜返流的患病率。设计和设置：在一所大学医院进行观察性病例对照研究。患者：50名接受治疗的患者（44名女性和6名男性）和50名性别和年龄匹配的对照受试者参与了研究;还研究了20名初治患者。干预：在接受治疗的患者中，卡麦角林的最后一次剂量为1.3 +/- 1.3 mg/wk（10%为3 mg/wk）。治疗持续时间为12-60个月的占32%，超过60个月的占68%。累计卡麦角林的剂量（mg x治疗月数）范围为32-1938 mg测量：根据美国超声心动图学会的建议评估瓣膜返流。结果：在初治患者、治疗患者和对照组中，（35、22和12%，P = 0.085）、主动脉瓣（0、4和2%，P = 0.59）、三尖瓣（55、30和42%，P = 0.13）或肺动脉瓣（20、12和6%，P = 0.22）相似。相反，治疗组中度三尖瓣返流的发生率（54%）高于初治组（0%）和对照组（18%，P < 0.0001）。中度三尖瓣返流在接受高于中位数的累积剂量的患者中（72%）比接受较低剂量的患者（36%，P = 0.023）更常见。一个较高的收缩压（P = 0.03）和舒张压（P < 0.0001）被发现在患者比那些没有中度三尖瓣返流。结论：中度三尖瓣返流是更常见的患者服用卡麦角林（在较高的累积剂量）比初治患者和对照组，但这一发现的临床意义尚未建立。对于长期接受卡麦角林治疗的患者，尤其是需要增加剂量的患者，需要进行完整的超声心动图评估。
Background: Cabergoline, a dopamine receptor-2 agonist used to treat prolactinomas, was associated with increased risk of cardiac valve disease in Parkinson's disease.Objective: Our objective was to evaluate prevalence of cardiac valve regurgitation in cabergoline-treated patients with prolactinomas.Design and Setting: An observational, case-control study was conducted at a university hospital.Patients: Fifty treated patients (44 women and six men) and 50 sex-and age-matched control subjects participated; 20 de novo patients were also studied.Intervention: In the treated patients, the last cabergoline dose was 1.3 +/- 1.3 mg/wk ( 3 mg/wk in 10%). Treatment duration was 12-60 months in 32% and more than 60 months in 68%. The cumulative (milligrams x months of treatment) dose of cabergoline ranged from 32-1938 mg (median 280 mg).Measurements: Valve regurgitation was assessed according to the recommendations of the American Society of Echocardiography.Results: In de novo patients, treated patients, and controls, the prevalence of mild regurgitation of mitral (35, 22, and 12%, P = 0.085), aortic (0, 4, and 2%, P = 0.59), tricuspid (55, 30, and 42%, P = 0.13) or pulmonic (20, 12, and 6%, P = 0.22) valves was similar. Conversely, the prevalence of moderate tricuspid regurgitation was higher in the treated patients (54%) than in de novo patients (0%) and controls (18%, P < 0.0001). Moderate tricuspid regurgitation was more frequent in patients receiving a cumulative dose above the median (72%) than in those receiving a lower dose (36%, P = 0.023). A higher systolic (P = 0.03) and diastolic blood pressure (P < 0.0001) was found in patients with than in those without moderate tricuspid regurgitation.Conclusion: Moderate tricuspid regurgitation is more frequent in patients taking cabergoline (at higher cumulative doses) than in de novo patients and control subjects, but the clinical significance of this finding has not been established. A complete echocardiographic assessment is indicated in patients treated long term with cabergoline, particularly in those requiring elevated doses.