Růžička E et al. (2007) Low incidence of restrictive valvulopathy in patients with Parkinson's disease on moderate doses of pergolide. J Neurol [doi:10.1007/s00415-007-0592-x]

A high incidence (∼33%) of restrictive valvular heart disease (VHD) has been reported in patients with Parkinson's disease (PD) receiving the ergot dopamine agonist pergolide. As a result of such observations, the therapeutic use of pergolide in PD has been restricted. Interestingly, however, a recent Czech study has demonstrated a low incidence of VHD in PD patients treated with only moderate doses of pergolide.

The study evaluated 90 patients with PD (mean age 60.8 years; mean disease duration 10.0 years) who were receiving a mean of 2.93 mg/day pergolide (range 0.75–5.0 mg/day). Mean duration of pergolide therapy was 51 months, and 79 patients were also receiving levodopa. No cases of restrictive VHD or severe valve insufficiency were found on echocardiography. Mild mitral regurgitation was observed in 40 (44%) patients, and in 13 (36%) of 36 control individuals. One patient had a moderate mitral regurgitation. Neither duration of pergolide treatment nor cumulative pergolide dose predicted mitral valve insufficiency. Discrete fibrotic changes on valves were observed in 10 (11%) patients, and degenerative changes were seen in 11 (12%) patients (compared with 19% of control individuals).

The authors attribute the absence of observed restrictive VHD to the relatively low doses of pergolide administered to the participants in their study. They suggest that pergolide doses not exceeding 3 mg/day could be considered for patients with PD, as long as these individuals undergo regular echocardiographic follow-up.