Heart valve regurgitation, pergolide use, and Parkinson disease

Objective: To investigate the prevalence and risk factors of heart valve disease in patients having PD treated with pergolide. Design: Prospective observational study. Setting: Patients were recruited at the Hopital de la Pitie-Salpe Salpetriere, Paris, France. Patients: Ninety-six patients having PD treated with pergolide for longer than 3 months vs 50 control subjects. Intervention: Standardized echocardiography performed by an investigator blinded to treatment status. Main Outcome Measure: Moderate to severe regurgitation in at least 1 heart valve. Results: One hundred thirty-three echocardiograms (86 in the pergolide-treated group and 47 in the control group) were analyzed in the study. Moderate to severe regurgitation was found in 15 patients treated with pergolide (17.4%) and in 2 control subjects (4.3%) (odds ratio [OR], 4.75; 95% confidence interval [CI], 1.02-22.1; P=.03). Moderate to severe regurgitation was associated with the cumulative dose of pergolide (OR, 1.37; 95% CI, 1.04-1.81 per 10-mg/ kg increase; P=. 03). Including the present study, the meta-analysis comprised 7 trials ( 394 patients treated with pergolide and 280 controls). The overall OR for moderate to severe regurgitation was 3.1 ( 95% CI, 1.7- 5.6; P<.001) in the pergolide-treated group. Risk differences were correlated with the mean cumulative dose of pergolide (r= 0.90, P<.001). Data Sources: Using an end point of moderate to severe heart valve regurgitation, we performed a meta-analysis of patients having Parkinson disease (PD) treated with pergolide mesylate vs control subjects by searching PubMed (January 1, 1966, to April 1, 2007) and the Cochrane databases to identify English-language prospective observational studies that reported echocardiographic data. Conclusion: Heart valve disease is independently associated with the use of pergolide treatment in patients having PD and correlates with its cumulative dose. Trial Registration: clinicaltrials. gov Identifier: NCT00202657.