Background: In contrast to cabergoline, evidence-based information about a possible profibrotic effect of bromocriptine in prolactinoma patients is extremely limited. Objective: To assess the prevalence of valvular lesions among patients on long-term bromocriptine or cabergoline therapy. Design: Case-control study. Methods: A transthoracic echocardiographic evaluation was performed in 334 subjects divided into four groups: 103 cabergoline treated, 55 bromocriptine treated, 74 naïve patients, and 102 controls. Results: Clinically relevant valve regurgitations were equally prevalent in all investigated groups whereas subclinical valve fibrosis was significantly more frequent in both bromocriptine-and cabergoline-treated patients (40 vs 43.6 vs 21.6 vs 23.5%; PZ0.004). The odds ratio (OR) for developing valvular fibrosis was 2.27 (95% CI 1.17-4.41; PZ0.016) for cabergoline and 2.66 (95% CI 1.22-5.78; PZ0.014) for bromocriptine groups compared with subjects not exposed to dopamine agonists (DAs). A significantly higher pulmonary arterial pressure corresponding to the longer treatment duration was observed among patients taking bromocriptine compared with cabergolinetreated subjects. Conclusions: Long-term treatment with cabergoline and bromocriptine seems not to be associated with an increased risk of clinically significant valve disease but possible subclinical lesions should be expected. An echocardiographic examination is recommended at the beginning and periodically during therapy with DAs acting as full or partial agonists of 5-hydroxytrytamine 2B receptors (cabergoline and bromocriptine). Bromocriptine seems not to be a safe alternative for patients receiving cabergoline treatment who have preexisting or diagnosed abnormalities suggesting valvular, interstitial myocardial, or pulmonary fibrosis. Further studies are needed to investigate the possible impact of DA treatment on pulmonary arterial pressure.
Cardiomyopathy is a frequent complication of pheochromocytoma and echocardiography is the most accessible method for its evaluation. The objective of this study was to assess the clinical significance of classical and novel echocardiographic parameters of cardiac function in 24 patients with pheochromocytomas (PPGL) compared to 24 subjects with essential hypertension (EH). Fourteen PPGL patients were reassessed after successful surgery. Left ventricular hypertrophy was four times more prevalent in patients with PPGL vs. EH (75% vs. 17%; p=0.00005). Left ventricular mass index (LVMi) significantly correlated with urine metanephrine (MN) (rs=0.452, p=0.00127) and normetanephrine (NMN) (rs=0.484, p=0.00049). Ejection fraction (EF) and endocardial fractional shortening (EFS) were normal in all participants and did not correlate with urine metanephrines. Global longitudinal strain (GLS) was significantly lower in PPGL compared to EH group (-16.54±1.83 vs. -19.43±2.19; p<0.00001) and revealed a moderate significant positive correlations with age (rs=0.489; p=0.015), LVMi (rs=0.576, p<0.0001), MN (rs=0.502, p=0.00028) and NMN (rs=0.580, p<0.0001). Relative wall thickness (RWT) showed a strong positive correlation with urine MN (rs=0.559, p<0.0001) and NMN (rs = 0.689, p<0.00001). Markedly decreased LVMi (118.2 ± 26.9 vs. 102.9 ± 22.3; p=0.007) and significant improvement in GLS (-16.64±1.49 vs. -19.57±1.28; p<0.001) was observed after surgery. ΔGLS depended significantly on the follow-up duration. In conclusion, classical echocardiographic parameters usually used for assessment of systolic cardiac function are not reliable tests in pheochromocytoma patients. Instead, GLS seems to be a better predictor for the severity and the reversibility of catecholamine-induced myocardial function damage in these subjects. RWT should be measured routinely as an early indicator of cardiac remodeling.
OBJECTIVE: To evaluate the effects of aliskiren on blood pressure and myocardial function assessed by global longitudinal strain in patients with uncontrolled arterial hypertension. PATIENTS AND METHODS: Forty-fi ve patients were included in the study (29 males, 16 females, mean age 58.7 ± 12.4 years) with BP > 140/90 mmHg despite treatment with combined antihypertensive therapy and echocardiographic data for diastolic dysfunction: Е/Е'ratio ≤ 8, Е/А ratio < 0.8, deceleration time (DT) > 200 msec. Aliskiren (2 х 150 mg per day) was added to the previous therapy. The follow-up period was 1 year, including monthly clinical visits. Echocardiographic assessment of the left ventricular function by longitudinal strain and Doppler analysis of the trans-mitral blood fl ow was performed at months 1, 6, 12. RESULTS: The baseline systolic and diastolic blood pressures scores were 153.4 ± 14.4/99.2 ± 6.7 mmHg and 157.6 ± 12.5/97.3 ± 8.2 mmHg for males and females, respectively. The systolic and diastolic values at 1 month were 131.7 ± 7.4/83.6 ± 5.2 mmHg for males and 132.4 ± 5.3/81.8 ± 6.9 mmHg for females (р < 0.05 vs. baseline). The baseline Е/Е' was 6.5 ± 0.9, Е/А -0.6 ± 001, DT -258 ± 32.7 msec. These indicators at month 12 were as follows: Е/Е' -7.0 ± 0.64, Е/А -0.7 ± 0.05, DT -239 ± 16.5 msec, р = NS. Baseline global longitudinal strain in males was -10.4 ± 0.7% and -11.0 ± 0.9% in females and at month 12 -16.3 ± 0.9% and -17.5 ± 0.7% for males and females, respectively, р < 0.05. For the period of follow-up no adverse effects due to aliskiren treatment were registered. CONCLUSIONS: Adding aliskiren to combined antihypertensive therapy leads to signifi cant improvement of hypertension control and myocardial function assessed by global longitudinal strain.
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