Cardiac valve regurgitation with pergolide compared with nonergot agonists in Parkinson disease

Background: Although most studies have suggested an increased risk of valvulopathy (primarily regurgitation) with pergolide mesylate use, one study suggested that this problem may also occur with use of the non-ergot-derived dopamine agonists pramipexole dihydrochloride and ropinirole hydrochloride. Objective: To determine if cardiac valve regurgitation occurs more commonly in patients with Parkinson disease (PD) treated with pergolide than in those treated with nonergot agonists at a comparable dose. Design: A case-control study of echocardiographic findings of valve function in patients receiving dopamine agonists for PD. Setting: University-based referral center. Patients: Thirty-six patients with idiopathic PD taking pergolide were compared with a matched control group of patients taking nonergot agonists with regard to the frequency and severity of cardiac valve regurgitation. Main Outcome Measure: Valve scores (1 indicates trace; 2, mild; 3, moderate; and 4, severe) for the pergolide group were compared with those for the nonergot agonist control group. Results: The mean +/- SD valve regurgitation scores in the matched pergolide group compared with the nonergot group were as follows: aortic, 0.83 +/- 1.23 vs 0.19 +/- 0.53 (P=.01); mitral, 1.42 +/- 1.0 vs 0.39 +/- 0.65 (P < .001); and tricuspid, 1.43 +/- 1.0 vs 0.19 +/- 0.53 (P < .001). Lifetime exposure to a dopamine agonist was not statistically different between the pergolide and nonergot agonist groups (P=.18). Conclusions: These data strengthen the conclusion that pergolide contributes to cardiac valve regurgitation when used in the long term as a treatment for PD. There appears to be low risk of cardiac valve regurgitation when using non-ergot-derived dopamine agonists.