Treatment of Parkinson’s disease with pergolide and relation to restrictive valvular heart disease
G Van Camp, A Flamez, B Cosyns, C Weytjens, L Muyldermans, M Van Zandjicke, J De Sutter, P Santens, P Decoodt, C Moerman, D Schoors
Lancet 2004;363:1179-1183

Use of pergolide may be associated with a high risk for restrictive valvular heart disease, according to this study. Previous studies of this phenomenon have indicated relatively low rates of valvular heart disease.

Seventy-eight consecutive PD patients treated with pergolide (mean duration of pergolide treatment 18.2 months) and 18 non-pergolide PD patients underwent echocardiography. Echocardiographs were read by an investigator blinded to treatment status, and severity of restrictive disease was rated from 1 (worst) to 4 (none).

Presence of any restrictive disease was recorded in 26 pergolide patients and no controls (p=0.0025). Clinically significant disease (score 1 or 2) was recorded in 15 patients, without an effect from current dose of drug. Cumulative dose was associated with severity of “tenting” of the mitral valve. One patient required heart surgery for valve replacement and repair. Pergolide treatment was stopped in 6 patients, 2 of whom showed improvement following drug cessation.

The authors conclude, “Although pergolide remains a good treatment for the symptoms of Parkinson’s disease, our findings underline the necessity to inform patients of the possible risk of inducing restrictive valvular heart disease and pulmonary hypertension. Clinicians must be aware of this possible side effect, and close clinical and echocardiographic follow-up is mandatory.”