Valvular Heart Disease in Patients with Prolactinomas on Cabergoline Treatment

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 88-129-Acromegaly & Prolactinoma
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-127
Diana Arrestia, Lucia Florio, Mauricio Gutierrez, Mariana Elhordoy, Elisa Seoane, Cristina Alonso and Maria Mercedes Pineyro*
Facultad de Medicina, Hospital de Clínicas, Montevideo, Uruguay
High dose treatment with dopamine agonists (cabergoline (CAB), pergolide) for Parkinson’s disease has been associated with valvular heart disease(VHD). The majority of studies in hyperprolactinemia patients treated with CAB showed no risk of valvular regurgitation (VR). Still, few studies reported an increased risk of mild to moderate VR.

Objective: To determine the association between treatment with CAB amongst patients with prolactinomas (PRO) and echocardiographic VHD.

Methods: An observational case-control study was performed. Twenty-two patients with PRO treated with CAB were compared with 22 sex-and age- matched controls recruited among medical staff or patients attending our clinic. A transthoracic echocardiogram was conducted by a single cardiologist and VR graded according to the American Society of Echocardiography.

Results: Patients (17 females and 5 males) with PRO on CAB treatment for 45 months (range 8-108) received cumulative doses of 102.8 mg (range 16-1962). Cases and controls were similar in regards to hypertension (13.6% vs. 22.7%; p=0.35), smoking (18.2% vs. 13.6%; p=0.50), diabetes mellitus (13.6% vs. 13.6%; p=0.67) and dyslipidemia (31.8% vs. 18.2% p=0.30). There was a trend towards BMI ≥ 25 kg/m2 being more prevalent on cases (72.7%) vs. controls (45.5%; p=0.07). There were neither cases of significant valvular thickening (>0.5 cm) nor moderate or severe VR. Prevalence of mild regurgitation (REG) was similar in both groups: one case of aortic REG (AR) in each group (p=0.76); 4 cases of mitral REG in cases vs.3 in controls (p=0.50) and 4 cases of tricuspid REG in cases vs. 1 control (p=0.17). There was no pulmonary valve REG. Both cases of mild AR presented with cardiovascular risk factors. The mitral tenting area was < 2 cm2 in all subjects. Despite no significant difference in mitral valve thickening(MVT) between groups (cases 2.29 mm vs. controls 2.08 mm; p=0.65), we found a significant correlation between cumulative CAB (CC) dose and MVT (p=0.003;r2=0.37). We did not have any patients with CC doses between 437 and 1962 mg. If we exclude the patient with the greatest MVT (3.8 mm), who received the highest CC dose (1962 mg), this correlation is not longer noted (p=0.75).  CAB-treated patients had lower left-ventricular ejection fraction (LVEF) (60.9% ± 1.97) compared to controls (64.8% ± 4.9;p=0.004). BMI ≥ 25 kg/m2was associated with significant lower LVEF(60%) compared to those with normal weight (65%; p=0.045). There was no correlation between CC dose or duration of treatment and significant VR or LVEF. 

Conclusions: CAB treatment was associated with greater MVT, but not with significant heart VR or valvular thickening. BMI may inversely correlate with cardiac function. Further studies are warranted to evaluate if CAB, at various doses and duration, may induce subclinical valvular changes. Also, asses if this changes may prove clinically significant in the long-term.

Nothing to Disclose: DA, LF, MG, ME, ES, CA, MMP

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