Cardiac valve disease and low-dose dopamine agonist therapy: an artefact of reporting bias?

TY - JOUR

T1 - Cardiac valve disease and low-dose dopamine agonist therapy

T2 - an artefact of reporting bias?

AU - Gu, Haotian

AU - Luck, Sara

AU - Carroll, Paul

AU - Powrie, Jake

AU - Chambers, John

PY - 2011/5

Y1 - 2011/5

N2 - IntroductionChronic low-dose cabergoline treatment for microprolactinoma may cause cardiac valve pathology, but the evidence is contradictory. We investigated whether the expectation of the echocardiographer could influence the report.MethodsTransthoracic echocardiograms from 40 patients aged 49 center dot 3 +/- 9 center dot 6 (mean +/- SD) years (Men:Women 7:33) on long-term cabergoline and bromocriptine therapy (duration 9 center dot 94 +/- 4 center dot 5 years) were randomly assigned to two groups of echocardiographers so that each echocardiogram was reported twice. One group was told that 'the patients were control subjects' (Group A) and the other that 'the patients were on dopamine agonist therapy which is known to cause valve disease' (Group B). An observer who was blind to the group scored the reports for regurgitation at each valve (scores 0-4; max 16 per case).ResultsMean total regurgitation score was significantly higher in Group B (1 center dot 43 +/- 1 center dot 28; P = 0 center dot 014) than in Group A (0 center dot 73 +/- 1 center dot 30). The difference was mainly from reporting trivial regurgitation: (mitral 16 vs 5, P = 0 center dot 005; tricuspid 17 vs 6, P = 0 center dot 007 and pulmonary 8 vs 1, P = 0 center dot 013). Mild regurgitation was uncommon (mitral 1 vs 1 and tricuspid 3 vs 6). Moderate regurgitation occurred in only one case and was associated with restriction of the leaflets consistent with the effects of cabergoline. Valve thickening was not reported in Group A, but in 9 (23%) mitral and 4 (10%) aortic valves in Group B.ConclusionLong-term, low-dose dopamine agonist therapy rarely causes cardiac valve disease, but operator bias can lead to over-reporting of both valve thickening and trivial regurgitation.

AB - IntroductionChronic low-dose cabergoline treatment for microprolactinoma may cause cardiac valve pathology, but the evidence is contradictory. We investigated whether the expectation of the echocardiographer could influence the report.MethodsTransthoracic echocardiograms from 40 patients aged 49 center dot 3 +/- 9 center dot 6 (mean +/- SD) years (Men:Women 7:33) on long-term cabergoline and bromocriptine therapy (duration 9 center dot 94 +/- 4 center dot 5 years) were randomly assigned to two groups of echocardiographers so that each echocardiogram was reported twice. One group was told that 'the patients were control subjects' (Group A) and the other that 'the patients were on dopamine agonist therapy which is known to cause valve disease' (Group B). An observer who was blind to the group scored the reports for regurgitation at each valve (scores 0-4; max 16 per case).ResultsMean total regurgitation score was significantly higher in Group B (1 center dot 43 +/- 1 center dot 28; P = 0 center dot 014) than in Group A (0 center dot 73 +/- 1 center dot 30). The difference was mainly from reporting trivial regurgitation: (mitral 16 vs 5, P = 0 center dot 005; tricuspid 17 vs 6, P = 0 center dot 007 and pulmonary 8 vs 1, P = 0 center dot 013). Mild regurgitation was uncommon (mitral 1 vs 1 and tricuspid 3 vs 6). Moderate regurgitation occurred in only one case and was associated with restriction of the leaflets consistent with the effects of cabergoline. Valve thickening was not reported in Group A, but in 9 (23%) mitral and 4 (10%) aortic valves in Group B.ConclusionLong-term, low-dose dopamine agonist therapy rarely causes cardiac valve disease, but operator bias can lead to over-reporting of both valve thickening and trivial regurgitation.

KW - VALVULAR HEART-DISEASE

KW - TRICUSPID REGURGITATION

KW - INCREASED PREVALENCE

KW - PARKINSONS-DISEASE

KW - CABERGOLINE

KW - HYPERPROLACTINEMIA

KW - RISK

U2 - 10.1111/j.1365-2265.2010.03973.x

DO - 10.1111/j.1365-2265.2010.03973.x

M3 - Article

SN - 0300-0664

VL - 74

SP - 608

EP - 610

JO - Clinical endocrinology

JF - Clinical endocrinology

IS - 5

ER -