ORIGINAL ARTICLE: Assessment of cardiac valve dysfunction in patients receiving cabergoline treatment for hyperprolactinaemia

Abstract

Our data demonstrates that there is no association between cabergoline treatment for hyperprolactinaemia and valvulopathy. This study therefore supports continued use of low-dose cabergoline for patients with hyperprolactinaemia.

Safety of long-term treatment with cabergoline on cardiac valve disease in patients with prolactinomas

“…Moreover, even though trivial valvulopathy was slightly increased after long-term treatment, the overall prevalence of mitral (25%) and tricuspid (45%) valvular regurgitations has been found to be not increased when compared with the general population, in line with the results of the Framingham Heart Study (45), showing an overall prevalence of any degree of mitral and tricuspid regurgitations in 88-91 and 82-86% of the general population respectively. In our series, the prevalence of mild aortic insufficiency (2.5%) was similar to the 2.7% reported by Tan et al (22), the 2% recorded by Elenkova et al (25), and the 3.9% found by Córdoba-Soriano et al (26) and within the 0-14% described in the general population (45). In our cohort of patients, none developed significant pulmonic regurgitation or arterial pulmonic hypertension, and none showed moderate or severe regurgitation of mitral and tricuspid valve.…”

“…Results from 15 observational studies investigating the risk of fibrotic valvulopathy in hyperprolactinemic patients treated with CAB have been published to date (13,14,15,16,17,18,19,20,21,22,23,24,25,26,27). Two of them (15,20) have shown no relevant findings.…”

“…Four studies (16,18,21,24) have demonstrated an increased prevalence of non-clinically relevant valve regurgitations, including mild tricuspid regurgitation (16,21,24), pulmonic insufficiency (16), or enlarged mitral tenting area (18). Ten trials (13,14,17,18,19,22,23,25,26,27) have reported a variable prevalence, ranging from 2% (25) to 54% (13), of relevant valvulopathy including moderate-to-severe mitral or tricuspid insufficiency and mild aortic regurgitation, with the latter being observed only in two investigations (22,24). Overall, a median CRVD rate of w4% has been reported in hyperprolactinemic patients receiving treatment with CAB.…”

“…Over the past 5 years, 15 independent studies (13,14,15,16,17,18,19,20,21,22,23,24,25,26,27) (Table 1) have investigated the effects of CAB on the development of CRVD in patients with prolactinomas. Overall, these studies have reported a median CRVD rate of w4%, with the prevalence of CRVD ranging from 54% (13), 40% (24), 15% (17) to 0% (15,16,19,21) and valvulopathy being assessed according to the International Guidelines suggested by the American Society of Echocardiography (28,29) in all studies and also according to the European Association of Echocardiography (30,31) in ten studies (13,16,17,18,20,22,23,25,26,27). Moreover, a significant correlation between cumulative dose of CAB and prevalence of valve disease has been demonstrated in only two reports (13,24), whereas the vast majority of studies have agreed on safety of treatment with CAB on valvulopathy in hyperprolactinemic patients.…”

Transforming growth factor β1 is not a reliable biomarker for valvular fibrosis but could be a potential serum marker for invasiveness of prolactinomas (pilot study)

“…Cabergoline, which possesses a complete 5HT 2b agonistic activity, is the drug of choice in the treatment of prolactinomas, but the results of observational studies investigating the risk of FVHD in these patients are still controversial. Some of them have reported no relevant findings (8,9,10,11,12), five trials have observed clinically insignificant valvular changes (13,14,15,16,17), and only one study has reported an increased prevalence of moderate tricuspid regurgitation with a cumulative dose-dependent risk (18). Published data on the potential profibrotic effect of bromocriptine, a partial 5HT 2b agonist, are exclusively limited (19).…”