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Pergolide-Related Restrictive Valvular Heart Disease More Common than Previously Reported in Patients with Parkinson's Disease

Patients with Parkinson's disease who are taking pergolide to help manage their symptoms develop restrictive valvular heart disease at rates higher than previously reported, according to data from a study conducted in Belgium.

"We noted a higher frequency of proven and important restrictive valvular heart disease in patients taking high-doses of pergolide than in those taking lower doses," writes Guy Van Camp, MD, Department of Cardiology, Free University Brussels, and colleagues.

The researchers assessed the frequency of valvular heart disease in patients with Parkinson's disease; 78 patients who were a mean age of 70.9 years treated with a mean cumulative dose of 3003 g pergolide for a mean duration of 18.2 months, and 18 control patients who were a mean age of 72.8 years not taking pergolide. The patients had no history of coronary or valvular heart disease, and had not used Chinese herbs, anorectic drugs, or other ergot-derived drugs.

The researchers quantified disease as follows: a score of 1 identified proven restrictive valvular heart disease through pathology, regression after interruption of pergolide treatment, or both; a score of 2 identified important valvular heart disease defined by regurgitant jet greater than or equal to 2/4 or restrictive tricuspid disease even if less than 2/4; a score of 3 identified mild to moderate restrictive valvular disease defined by restrictive jet less than 2/4; and a score of 4 showed no restrictive valvular dysfunction.

Of the patients taking pergolide, 33% had restrictive valvular heart disease scores of 1 to 3, and 19% of these had scores of 1 or 2, compared with no disease in the control group. Overall, 42% of the patients treated with high-dose pergolide (5 mg daily or more) and 29% of those treated with low-dose pergolide (less than 5 mg daily) had restrictive valvular heart disease.

Patients with restrictive mitral valves had mean tenting distances of 1.08 mm and mean tenting areas of 2.39 mm², compared with 0.63 mm and 1.39 mm², respectively, in those with non-restrictive mitral valves. The control patients had corresponding values 0.54 mm and 1.27 mm/2, respectively.

The high-dose pergolide group had mean systolic pulmonary artery pressures of 39.3 mm Hg compared with 38.5 mm Hg in the low-dose group, and 31 mm Hg in controls compared with all patients taking pergolide.

Six patients ceased pergolide therapy due to restrictive valvular heart disease, which subsequently regressed in 2 patients.

"Although pergolide remains a good treatment for the symptoms of Parkinson's disease, our findings underline the necessity to inform patients of the possible risk of inducing restrictive valvular heart disease and pulmonary hypertension," the authors conclude.

Lancet 2004;363:1170-83.

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