David Gamble1, Rachel Fairley2, Roderick Harvey3, Colin Farman3, Nathan Cantley3, Stephen J Leslie4. 1. University of Aberdeen, Aberdeen Royal Infirmary, NHS Grampian, Foresterhill, Aberdeen, UK. 2. NHS Highland Medicine Information, Pharmacy Department, Raigmore Hospital, Inverness, UK. 3. Raigmore Hospital, NHS Highland, Old Perth Road, Inverness, UK. 4. Cardiac Unit, Raigmore Hospital, NHS Highland, Old Perth Road, Inverness IV2 3UJ, UK.
Abstract
OBJECTIVES: The indication for screening for valvular heart disease in patients taking cabergoline is based on evidence from patients with Parkinson's disease on high-dose medication. However, current patients take much lower doses for indications such as hyperprolactinaemia disorders. Contemporary guidelines for echocardiogram monitoring in patients taking cabergoline are conflicting. This study aimed to review current clinical practice in our area regarding echocardiographic screening and to review the literature examining the evidence of valvular heart disease in patients taking lower dose cabergoline. METHODS: This was a retrospective study of all patients with hyperprolactinaemia disorders prescribed cabergoline in a single UK NHS health board between January 2014 and July 2015. The proportion of patients receiving baseline and follow-up echocardiograms was recorded. A review of the published literature was carried out using the databases EMBASE and Medline to examine the current evidence for the effect cabergoline has on cardiac valves in patients treated for hyperprolactinaemia disorders. RESULTS: The mean age was 51.7 ± 16.5 years with a 64.4% female predominance. The mean duration of therapy was 5.9 years ± 4.1 years. Of the total cohort (n = 45), two (4.4%) patients had an initial baseline echocardiogram and five (13.2%) had follow-up echocardiograms every 24 months. Of the 25 articles identified, 12 showed no clinically significant evidence of valvular dysfunction in the cabergoline group groups. Of the remaining 13 articles, evidence for valvular changes was confined to high cumulative dose cabergoline patients and there was only one confirmed case of 'cabergoline associated valvulopathy' described. CONCLUSIONS: Clinically significant valvular dysfunction is uncommon and generally only reported in high cumulative dose treatment groups. We propose that clearer national guidelines are required and that echocardiogram screening be reserved for patients who are high risk, are taking a high weekly dose (≥2 mg cabergoline weekly) or high cumulative dose.
OBJECTIVES: The indication for screening for valvular heart disease in patients taking cabergoline is based on evidence from patients with Parkinson's disease on high-dose medication. However, current patients take much lower doses for indications such as hyperprolactinaemia disorders. Contemporary guidelines for echocardiogram monitoring in patients taking cabergoline are conflicting. This study aimed to review current clinical practice in our area regarding echocardiographic screening and to review the literature examining the evidence of valvular heart disease in patients taking lower dose cabergoline. METHODS: This was a retrospective study of all patients with hyperprolactinaemia disorders prescribed cabergoline in a single UK NHS health board between January 2014 and July 2015. The proportion of patients receiving baseline and follow-up echocardiograms was recorded. A review of the published literature was carried out using the databases EMBASE and Medline to examine the current evidence for the effect cabergoline has on cardiac valves in patients treated for hyperprolactinaemia disorders. RESULTS: The mean age was 51.7 ± 16.5 years with a 64.4% female predominance. The mean duration of therapy was 5.9 years ± 4.1 years. Of the total cohort (n = 45), two (4.4%) patients had an initial baseline echocardiogram and five (13.2%) had follow-up echocardiograms every 24 months. Of the 25 articles identified, 12 showed no clinically significant evidence of valvular dysfunction in the cabergoline group groups. Of the remaining 13 articles, evidence for valvular changes was confined to high cumulative dose cabergolinepatients and there was only one confirmed case of 'cabergoline associated valvulopathy' described. CONCLUSIONS: Clinically significant valvular dysfunction is uncommon and generally only reported in high cumulative dose treatment groups. We propose that clearer national guidelines are required and that echocardiogram screening be reserved for patients who are high risk, are taking a high weekly dose (≥2 mg cabergoline weekly) or high cumulative dose.
Authors: Victoria Delgado; Nienke R Biermasz; Sjoerd W van Thiel; See H Ewe; Nina Ajmone Marsan; Eduard R Holman; Richard A Feelders; Johannes W A Smit; Jeroen J Bax; Alberto M Pereira Journal: Clin Endocrinol (Oxf) Date: 2012-07 Impact factor: 3.478
Authors: Lisa B Nachtigall; Elena Valassi; Janet Lo; David McCarty; Jonathan Passeri; Beverly M K Biller; Karen K Miller; Andrea Utz; Steven Grinspoon; Elizabeth A Lawson; Anne Klibanski Journal: Clin Endocrinol (Oxf) Date: 2009-04-17 Impact factor: 3.478
Authors: F Bogazzi; S Buralli; L Manetti; V Raffaelli; T Cigni; M Lombardi; F Boresi; S Taddei; A Salvetti; E Martino Journal: Int J Clin Pract Date: 2008-05-06 Impact factor: 2.503
Authors: Ana Carolina Correa E Castro; Andressa Alexandre de Araujo; Mariana Coelho Botelho; João Bosco Nascimento; Rafaela Marchon de Souza; Monica Roberto Gadelha; Antonio E Nardi; Alice Helena Dutra Violante Journal: Front Psychiatry Date: 2022-05-26 Impact factor: 5.435