Severe multivalvular heart disease: A new complication of the ergot derivative dopamine agonists
Severe multivalvular heart disease: A new complication of the ergot derivative dopamine agonists
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DOI：
10.1002/mds.20201
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发表时间：
2004-06-01
影响因子：
8.6
通讯作者：
Lang, AE
中科院分区：
文献类型：
--
作者：
Horvath, J;Fross, RD;Lang, AE
我们报告了 4 例接受麦角衍生物多巴胺激动剂培高利特和卡麦角林治疗的帕金森病患者出现瓣膜性心脏病的新病例。据报道，类癌综合征患者会发生心脏瓣膜非炎性纤维变性，并且有时会使抗偏头痛麦角生物碱麦角胺和美西麦角以及食欲抑制剂芬氟拉明和右芬氟拉明的治疗变得复杂。在这些病例中，怀疑其发病机制涉及通过 5-HT2B 受体介导的血清素介导的异常纤维发生，该受体在心脏瓣膜的成纤维细胞中表达。基于惊人相似的超声心动图和组织病理学特征，我们强烈怀疑麦角衍生的多巴胺激动剂可能导致与这些情况几乎相同的瓣膜性心脏病。这些病例增加了快速增长且令人担忧的类似已发表报告的清单，表明我们很可能面临此类药物的一种新颖但未被认识的并发症，此类药物不仅广泛用于帕金森病，还广泛用于不宁腿综合症和各种常见的内分泌功能障碍。因此，在更多地了解这种副作用的真实发生率之前，我们建议在麦角衍生物多巴胺激动剂长期治疗之前和过程中对心脏功能进行评估。 (C) 2004 年运动障碍协会。
We report on 4 new cases of valvular heart disease in Parkinson's disease patients treated with the ergot derivative dopamine agonists pergolide and cabergoline. Noninflammatory fibrotic degeneration of cardiac valves has been reported to occur in patients with carcinoid syndrome and to occasionally complicate therapies with the anti-migraine ergot alkaloid ergotamine and methysergide and with the appetite suppressants fenfluramine and dexfenfluramine. In these cases, the pathogenesis is suspected to involve serotonin-mediated abnormal fibrogenesis by means of the 5-HT2B receptors, which are expressed in the fibroblasts of heart valves. Based on strikingly similar echocardiographic and histopathological features, we strongly suspect that ergot-derived dopamine agonists may cause a valvular heart disease nearly identical to that seen in those conditions. These cases add to a rapidly growing and worrying list of similar published reports, suggesting that we may well be facing a novel, yet unrecognized, complication of this class of agents, which are widely used not only in Parkinson's disease but also in restless legs syndrome and various common endocrine dysfunctions. Therefore, until more is known about the true prevalence of this side effect, we propose that an assessment of cardiac function be performed before and in the course of a long-term therapy with ergot derivative dopamine agonists. (C) 2004 Movement Disorder Society.