Echocardiographic assessment of cardiac valves morphology and function in patients with prolactinomas under long-term treatment with cabergoline or bromocriptine
Atanaska Elenkova, Sabina Zacharieva & Rabhat Shabani
Background: Long-term treatment with dopamine agonists (DAs) is considered to be the first-choice therapy for prolactinomas. According to current guidelines DAs can be safely withdrawn in patients with negative pituitary MRI and stable normalization of prolactin levels for at least 3 years. On the other hand, recent studies have shown an increased risk for valvular heart disease in patients with Parkinsons disease treated with high doses of cabergoline. The aim of this study was to assess the prevalence of valvular lesions among prolactinoma patients treated with 2 different DAs (Bromocriptine or Cabergoline).
Methods: We performed an echocardiographic study in 167 subjects divided into 5 groups: 38 patients treated with Cabergoline for up to 3 years (treatment duration 636 months); 31 pts under long-term Cabergoline treatment (treatment duration 4084 months); 37 pts on Bromocriptine; 31 newly diagnosed with prolactinoma and 30 age-matched healthy subjects. Subjects with chronic heart disease were excluded from the trial. Severity of valve regurgitation was categorized as none (grade 0); trace (1); mild (2); moderate (3) and severe (grade 4).
Results: We did not find any significant differences in prevalence of mitral regurgitation grade 1 to 2 (13.5 vs 12.9 vs 10.8 vs 16.1 vs 10.2%) and mild tricuspid regurgitation (39.5 vs 58.1 vs 35.1 vs 54.8 vs 35.6%; P=0.158) in our investigated groups. None of investigated subjects presented with pulmonary valve lesions. A non-significant increase in the prevalence of mild aortic regurgitation was observed in patients under long-term treatment with cabergoline (9.7 vs 0%; P=0.064). Clinically important valve regurgitation (moderate or severe, grade 3 and 4) was not found.
Conclusions: In contrast to chronic treatment with high dose cabergoline in patients with Parkinsons disease the low-dose long-term therapy in prolactinoma patients appears not to be associated with an increased risk of valvular heart disease.
Keywords: valvular heart disease; prolactinoma; cabergoline; bromocriptine.