Elastic aortic properties in cystic fibrosis adults without cardiovascular risk factors: A case-control study.

INTRODUCTION: The presence of CFTR in smooth muscle and endothelial cells, systemic inflammation, and oxidative stress could explain vascular alterations in cystic fibrosis. Aortic elastic properties are determinants of left ventricular function by means of ventriculo-arterial coupling and indicators of cardiovascular risk. OBJECTIVES: The purpose of the present study was to compare clinically stable patients affected by cystic fibrosis without overt pulmonary hypertension with controls to evaluate aortic tissue Doppler elastic properties, such as distensibility, stiffness, and strain. METHODS: A total of 22 adults affected by cystic fibrosis, and 24 healthy volunteers matched for age and sex were enrolled. None had known cardiovascular risk factors, secondary diabetes, neither aortic stenosis nor regurgitation. All people underwent blood pressure measurement and transthoracic echocardiography. RESULTS: Aortic diameter measured at Valsalva sinuses was significantly higher in patients with cystic fibrosis than healthy people, median 32.0 (interquartile range 29.8-35.0) vs 24.3 (22.2-30.0) mm; P < 0.001. Aortic distensibility was significantly lower among patients than controls, being 2.4 (1.3-3.3) vs 5.6 (3.4-8.3) per mm Hg (P < 0.001), while stiffness higher, 7.7 (6.0-14.8) vs 3.7 (2.9-6.7); P < 0.001. Finally, M-mode strain of ascending aorta was lower in patients, 4.1 (3.4-7.3)% than in controls, 13.4 (7.7-19.4)%; P < 0.001. CONCLUSION: For the first time in humans, we demonstrated subclinical alterations in aortic elastic properties in young adults affected by cystic fibrosis without pulmonary hypertension or secondary diabetes. This phenomenon could influence left ventricular function earlier by means of ventriculo-arterial coupling and may be a tool to identify patients who benefit from a closer follow-up.

The Effect of Chorionicity on Maternal Cardiac Adaptation to Uncomplicated Twin Pregnancy: A Prospective Longitudinal Study.

OBJECTIVE: The objective of this study was to longitudinally evaluate maternal echocardiographic findings in uncomplicated twin gestations according to chorionicity. METHODS: Healthy women with twin pregnancy were assessed with transthoracic echocardiography across the first, second, and third trimesters. Cardiac findings were compared within each group and between monochorionic (MC) and dicho-rionic (DC) pregnancies. RESULTS: Overall, 19 MC and 48 DC uncomplicated twin pregnancies were included. In the MC group, no significant maternal haemodynamic changes were documented across gestation, with the exception of a decrease in ejection fraction. Compared to DC pregnancies, in the MC set lower cardiac output (second and third trimester, p = 0.001 and p = 0.006, respectively) and higher total vascular resistance (first trimester, p = 0.032) were observed. Regarding the diastolic function in MC twins, significantly higher values were observed for mitral E/A ratio (third trimester, p = 0.014), septal mitral E1/A1 ratio (third trimester, p = 0.030), lateral mitral E1 (second and third trimester, p = 0.014 and p = 0.029, respectively), and E1/A1 ratio (third trimester, p = 0.006). CONCLUSIONS: Maternal cardiac adaptation in twin pregnancy seems to differ significantly according to chorionicity. In particular, in MC pregnancies the impairment of diastolic function is less pronounced, presumably due to the lower circulating volume.

The role of heart rate and ivabradine in acute heart failure.

Resting heart rate (HR) is considered a powerful predictor of mortality both in healthy subjects and in cardiovascular (CV) patients, including those affected by heart failure (HF). Its reduction below 70 bpm is the treatment target in chronic HF with reduced ejection fraction (HFrEF) when sinus rhythm is present. In acute HF (AHF) HR is usually elevated but its role as risk marker is still unknown. Notably, in unstable patients, beta-blockers can be reduced or stopped, thus enhancing this phenomenon. Moreover, some data in literature suggest that HR reduction during hospitalization or HR at discharge or in the vulnerable phase after it are more predictive of early-term events and may be therapeutic targets. On the other hand, ivabradine is a pure HR-lowering drug with no effects on inotropism. Its role in the AHF setting has been recently investigated and is the object of this review.

Wellens' syndrome: a case report with atypical features.

Wellens' syndrome is a pattern of electrocardiographic T-wave changes seen in the precordial leads in patients with unstable angina. Two different patterns have been described. Type A presents with biphasic T-waves in V2-V3 and type B presents with symmetrical deep T-wave inversions in V2-V3. The etiology is related to a critical stenosis in the proximal left anterior descending artery (LAD). We describe a patient who presented at our emergency department with intermittent chest pain and showing Wellens' pattern T-wave inversions in the precordial leads of the electrocardiogram. She was found to have 95% stenosis in mid LAD.

Macro- and microvascular functions in cystic fibrosis adults without cardiovascular risk factors: A case-control study.

Increasing survival from cystic fibrosis show untypical systems involvement, such as cardiocirculatory. In particular, the presence of CFTR in smooth muscle and endothelial cells, systemic inflammation and oxidative stress could explain vascular alterations in these patients. We aimed at noninvasely evaluating macro- and microvascular dysfunction in cystic fibrosis adults without cardiovascular risk factors. Twenty-twoadults affected by cystic fibrosis and 24 healthy volunteers matched for age and sex were enrolled. None had known cardiovascular risk factors. All people underwent blood pressure measurement, microvascular function assessment by EndoPAT-2000 device (calculating RH-PAT index) and macrovascular evaluation by pulse wave velocity (PWV). RH-PAT index was significantly lower in patients than in controls (1.74±0.59 vs 2.33±0.34; p<0.001). Thirteen patients of 22 had a value inferior to the threshold of 1.67 (59.1%), while no controls had (p<0.001). Carotid-femoral PWV did not differ between the two groups (5.2±1.5 m/s vs 5.4±1.1; p=0.9), while brachial-ankle one did (11.0±2.2 m/s vs 10.1±0.8 m/s; p=0.04).Adults patients affected by cystic fibrosis show peripheral endothelial dysfunction, which is the first alteration in atherosclerotic phenomenon. Moreover, arterial stiffness measured by PWV unclearly seems to differ respect of healthy people, perhaps because PWV alterations are typical of above 50 years old people. It is unclear what prognostic role of future developing of atherosclerotic disease these findings could be, but it seems evident that cystic fibrosis directly affects cardiovascular system itself.

Prognostic evaluation of the elastic properties of the ascending aorta in dilated cardiomyopathy.

BACKGROUND: Nowadays there is an increased interest in the role of aortic stiffness in the pathophysiology of heart failure (HF), as it is a major determinant of left ventricular (LV) performance. We aimed at assessing the predictive value of the aortic stiffness parameters, measured by echocardiography, in patients affected by nonischaemic dilated cardiomyopathy (DCM) regarding three end-points: death, HF rehospitalization, combined death or HF rehospitalization in a long-term follow-up. MATERIALS AND METHODS: A total of 202 patients affected by nonischaemic DCM underwent an outpatient examination by echocardiography and blood pressure check at the brachial artery, in order to calculate aortic elastic properties (ie, compliance, distensibility, stiffness index, Peterson's elastic modulus, M-mode strain). ROC curves, Kaplan-Meier curves and multivariable Cox regressions (correcting for age, LV ejection fraction (LVEF), atrial fibrillation, cardiac resynchronization therapy (CRT)) were run to assess the predictive ability of aortic elastic properties against the 3 end-points. RESULTS: Mean follow-up was 9.83 ± 2.80 years. 24.8% of patients died, while 34.7% were rehospitalized for HF cause and 44.6% experienced the combined end-point. LVEF did not correlate with aortic elastic properties. ROC curves and Kaplan-Meier curves were elaborated. Aortic stiffness did not predict death in our cohort. Otherwise, all aortic elastic properties predicted HF rehospitalization and combined death or HF rehospitalization, after correcting for age, LVEF, atrial fibrillation, CRT. CONCLUSIONS: Elastic properties of the ascending aorta measured by echocardiography in patients with nonischaemic DCM predict long-term HF rehospitalization and combined death or HF rehospitalization, also after correcting for the confounding factors.

The role of type 2 diabetes mellitus on hypertensive-related aortic stiffness.

BACKGROUND: Hypertension is strongly related to arterial stiffness in a cause-effect fashion. Diabetes mellitus is also thought to determine vascular damage, mostly by means of advanced glycosylation end-products (AGEs). Aim of our study was to study the role of type 2 diabetes mellitus (T2DM) as regard ascending aortic elastic properties in hypertensive patients. METHODS: We prospectively enrolled outpatients with hypertension (n = 99) and type 2 diabetes mellitus plus hypertension (n = 42) without cardiovascular events. They underwent a transthoracic echocardiography to measure aortic diameters, aortic elastic properties (ie, compliance, distensibility, stiffness index, Peterson's elastic modulus, pulse wave velocity, M-mode strain), tissue Doppler imaging (TDI) to calculate diastolic (E' and A') and systolic (S') velocities, and tissue strain. Multivariable analysis was run to assess the association between T2DM and these variables after correcting for possible confounders (age, sex, body mass index [BMI], dyslipidemia). RESULTS: The two groups did not differ as regards age, sex, BMI, and blood pressure. However, T2DM patients were more likely to be dyslipidemic (43% vs 71%, P = .003). Aortic diameters were similar in the two groups, but the aortic elastic properties significantly more impaired in T2DM group. At multivariable analysis, stiffness index, Peterson's elastic modulus, the TDI waves, and the tissue strain remained associated with the co-presence of T2DM and hypertension. CONCLUSION: Our data suggest that people suffering from both T2DM and hypertension have more impaired aortic elastic properties than those hypertensive alone. Considering the prognostic role of aortic stiffness, these patients may benefit from a closer follow-up.

Kounis syndrome, a disease to know: Case report and review of the literature.

The case deals with an anaphylactoid reaction to intravenous ampicillin/sulbactam resulting in cardiogenic syncope and myocardial damage. Symptoms and ECG modifications promptly disappeared after corticosteroids administration. The Kounis syndrome is an acute coronary syndrome, including coronary spasm, acute myocardial infarction and stent thrombosis, resulting from an anaphylactic or anaphylactoid or allergic or hypersensitivity insult. First described in 1991, it can be caused by a lot of substances, particularly antibiotics. The management should be directed to both the allergic reaction and the myocardial damage. The Kounis syndrome is a not rare disease that every physician should know because of the wideness of triggers and the possible fatal evolution if not promptly recognized.

Echocardiographic evaluation of diastolic dysfunction in young and healthy patients with psoriasis: A case-control study.

Psoriasis is a systemic inflammatory disease with a great prevalence in general population. The inappropriate activation of the cellular immune system has been hypothesized to be an independent cardiovascular risk factor, given the higher incidence of cardiovascular disorders in psoriatic patients. Echocardiographic abnormalities have been demonstrated too: the aim of our study was to evaluate the presence of preclinical cardiac dysfunction in a cohort of psoriatic patients without cardiovascular risk factors. We enrolled 52 patients with the diagnosis of chronic plaque psoriasis, compared with a control group not affected by any relevant systemic diseases and inflammatory disorders. In all patients and control group, echocardiographic conventional and tissue Doppler (TDI) studies were conducted. The analysis of echocardiographic parameters revealed normal dimension, mass and systolic function of the left ventricle. Left ventricular diastolic dysfunction was found in 36.5% patients in the psoriasis group versus 0% in control group, and significant reduction of the E/A ratio was found also for the right ventricle. A significant increase of mitral regurgitation has been found in psoriatic patients (p=0.005). The early recognition of cardiovascular pre-clinic disease in psoriatic patients may guide a strict follow up and an early treatment, potentially improving cardiovascular prognosis.

Red cell distribution width and chronic heart failure: prognostic role beyond echocardiographic parameters.

AIM: Red cell distribution width (RDW) is a measure of anisocytosis. Higher values are robustly associated to adverse outcome in several conditions, including chronic heart failure (HF). The present study aimed to compared its prognostic role with that of echocardiographic parameters in this kind of patients. METHODS: 32 stable and optimally treated chronic HF patients were enrolled. We excluded subjects suffering from valvular diseases or atrial fibrillation. They underwent blood sampling and echocardiographic examination. The primary endpoint of the study was cardiovascular death and/or HF hospitalization in the first year after enrolment. RESULTS: 49 patients reached the primary endpoint. RDW best cut-off at ROC curve was 14.45%. Univariate analysis associated mitral regurgitation grade, left ventricular ejection fraction (LVEF), posterior wall thickness (PWT), LV mass index, and RDW>14.45% to the primary endpoint. Multivariate regression analysis showed that LVEF, PWT, and RDW>14.45% predict the primary endpoint. Area under ROC curve was 0.808 for LVEF, 0.762 for NYHA class, and 0.761 for RDW. CONCLUSION: In chronic HF patients RDW is a better predictor of adverse outcome than several echocardiographic parameters associated to outcome itself (LV mass index, mitral regurgitation grade), predicts prognosis even adjusting for those parameters, age and NYHA class, and is associated to several echocardiographic measurements. In conclusion, RDW can expand our tool bag in order to better follow-up these patients.

Left ventricular function in rheumatoid arthritis during anti-TNF-α treatment: a speckle tracking prospective echocardiographic study.

AIM: Rheumatoid arthritis (RA) shows a high risk for cardiovascular disease, including heart failure. Although TNF-α has been implicated in the pathogenesis of myocardial remodelling, TNF-α inhibition did not show any efficacy in patients with advanced heart failure and should be contraindicated in RA with cardiac complications. We aimed to assess global left ventricular (LV) systolic function using global longitudinal strain (GLS) as a measure of myocardial deformation, in a group of RA patients before and during anti-TNF-α treatment. METHODS: 13 patients (female:male 7:6) affected by RA were prospectively followed for one year during anti TNF-α treatment. Every subject underwent echocardiography before starting anti-TNF-α drugs and after one year of treatment, to evaluate LV ejection fraction (EF), telediastolic diameter, telediastolic volume and global longitudinal strain (GLS) that was calculated using 2D speckle tracking as the mean GLS from three standard apical views (2, 3 and 4 -chambers). The patients showed a mean age of 43 years at RA onset (SD: 13) and a mean follow-up of 7.3 years (SD: 4.8). Steroid and methotrexate were used in 84.6% and 100%, respectively, in association with etanercept (6 cases), adalimumab (4 cases) and infliximab (3 cases). RESULTS: Patients globally showed a normal EF before and after one year of treatment (mean: 65% and 65.7%, respectively). GLS did not differ before or after anti-TNF-α treatment (mean: -15.8% and -16.7%, respectively). CONCLUSION: Anti-TNF-α treatment did not significantly modify myocardial contractility after 12 months.

Prognostic value of RV isovolumic acceleration and tissue strain in moderate HFrEF.

BACKGROUND: Right ventricular (RV) dysfunction in heart failure (HF) with reduced left ventricular ejection fraction (LVEF) is associated with a poorer prognosis. No studies to date have investigated the prognostic utility of RV isovolumic acceleration (IVA) measured at tissue Doppler imaging (TDI) in HF. RV strain instead has been already correlated to a poorer prognosis in these patients. We aimed to assess the predictive value of both parameters in this context. MATERIALS AND METHODS: Sixty patients enrolled, NYHA II-III. Everyone underwent echocardiographic examination including TDI and strain analysis. Adverse event was defined as cardiovascular death or rehospitalization. RESULTS: Follow-up was 32 ± 13 months. Sixteen patients (26·7%) had an adverse event. IVA and RV strain were significantly lower in these patients. At logistic regression, they were both related to adverse event and their receiver operating characteristic (ROC) curve predictive (area under ROC 0·916 and 0·952, respectively). Kaplan-Meier survival curves were significantly worse for both parameters inferior to their respective means (P < 0·001 for both). Univariate and multivariate analyses confirmed their better utility than tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC) or S' at TDI. CONCLUSIONS: our study demonstrated a useful prognostic role of RV strain and IVA, which are parameters of subclinical RV impairment. Patients with low values may benefit from a more aggressive therapy and a closer follow-up.

Echocardiographic evaluation in subjects with α1-Antitrypsin deficiency.

BACKGROUND: α1-Antitrypsin (AAT) deficiency (AATD) is a genetic condition associated with early-onset panacinar emphysema and, less often, vascular disease. Recently, abnormal elastic properties of ascending aortic wall were described in ZZ genotype AATD subjects who incidentally showed an increased left ventricular mass. MATERIALS AND METHODS: To evaluate biventricular dimensions, valvular apparatus, systolic and diastolic function, 33 AATD subjects with ZZ genotype and 33 healthy subjects matched for age and sex underwent a complete echocardiographic assessment. RESULTS: Compared to controls, AATD subjects showed increased left ventricular mass (160 ± 59 g vs. 121 ± 70 g, P < 0.001), a higher incidence of left and right ventricular diastolic dysfunction (30% vs. 16%, P < 0.001 and 45% vs. 20%, P < 0.001, respectively) and mitral valve prolapse (35% vs. 6%, P < 0.001). In contrast, there was no difference between the two groups in diameters and systolic function of both ventricles and in the ejection fraction of left ventricle. The functions of aortic and tricuspidal valves were also similar. CONCLUSIONS: In the presence of greater left ventricular mass, a significantly higher incidence of left and right ventricular diastolic dysfunction and mitral valve prolapse occurs in AATD subjects (ZZ genotype). These findings strongly suggest an abnormal remodelling process in cardiac tissue in AATD.

Quantitative analysis of right ventricular (RV) function with echocardiography in chronic heart failure with no or mild RV dysfunction: comparison with cardiac magnetic resonance imaging.

OBJECTIVES: Right ventricular (RV) performance parameters (tricuspid annular plane systolic excursion, systolic longitudinal velocity on tissue Doppler imaging, fractional area change, and tissue and 2-dimensional [2D] strain on the right free wall) have been validated. In comparative studies, they have been correlated with the prognosis of patients with heart failure on radionuclide ventriculography and thermodilution in right heart catheterization. This study aimed to evaluate RV systolic function in patients with heart failure with no or mild RV dysfunction and correlate the above-mentioned echocardiographic parameters with the magnetic resonance imaging (MRI)-calculated RV ejection fraction (RVEF), stroke volume, end-diastolic volume, and end-systolic volume. METHODS: Standard and pulsed Doppler tissue echocardiography and MRI were performed in 31 patients with New York Heart Association functional class II and III chronic heart failure. RESULTS: A high correlation between tricuspid annular plane systolic excursion, systolic longitudinal velocity, tissue strain, and 2D strain was noted, whereas the fractional area change did not correlate with any other parameter. The RVEF correlated with tricuspid annular plane systolic excursion, systolic longitudinal velocity, and tissue and 2D strain (all P< .01); under linear regression analysis, the 4 parameters independently correlated with RVEF. CONCLUSIONS: Echocardiographic RV performance parameters (tricuspid annular plane systolic excursion, systolic longitudinal velocity, tissue strain, and 2D strain) correlated with the MRI-calculated RVEF and overall predicted it. In particular, RV 2D strain and tissue strain were good markers for RV longitudinal motions. These echocardiographic parameters are easily obtained and may give important information about RV function for evaluation and prognostic stratification of patients with heart failure.

Echocardiographic evaluation of aortic atheromas in patients with aortic stenosis.

OBJECTIVES: The association of aortic atheromas in patients with isolated aortic stenosis has recently been acknowledged, probably because the pathogenic mechanisms are similar. Therefore, this study evaluated the extent and severity of thoracic aortic atheromas in patients with different grades of aortic stenosis using transesophageal echocardiography. METHODS: We retrospectively evaluated transesophageal echocardiographic examinations of 686 consecutive patients with a diagnosis of aortic stenosis. The prevalence and morphologic characteristics of atheromas in 3 segments of the thoracic aorta were assessed. Plaque thickness was measured at each segment, and the thickest plaque was used to establish severity. Atheromas were graded as mild, moderate, or severe according to plaque thickness (<2, 2-4, or >4 mm, respectively). Aortic stenosis was graded as mild, moderate, or severe on the basis of the gradient and anatomic aortic valve area (>1.5, 1.0-1.5, or <1.0 cm(2)). RESULTS: A total of 382 patients were men, and 304 were women (mean age ± SD, 74 ± 15 years); 86% of the patients had aortic atheromas. The severe stenosis group had a significantly higher rate of atheromas (95% versus 40%; P < .001) than the mild stenosis group, with more complex atheromas (52% versus 22%; P< .001). There was no significant difference in the atheroma grades between the severe and moderate stenosis groups, but moderate cases had more moderate and severe atheromas than mild cases (45% and 15% versus 19% and 3%; P < .01). CONCLUSIONS: This study showed a correlation in the extent of aortic atheromas across several degrees of aortic stenosis. Patients with moderate and severe stenosis had more extensive atherosclerotic atheromas than those with mild stenosis.

Biventricular Tako-Tsubo cardiomyopathy: usefulness of 2D speckle tracking strain echocardiography.

Tako-Tsubo cardiomyopathy is a transient left ventricular apical ballooning syndrome also known as stress-induced cardiomyopathy. This reversible cardiomyopathy without epicardial coronary artery disease mimics acute myocardial infarction. Right ventricular involvement, which has been infrequently reported, is present in about a quarter of cases of Tako-Tsubo cardiomyopathy and is associated with a more severe clinical outcome. We report the case of a 55-year-old postmenopausal woman with transient biventricular apical ballooning. She recently had acute exacerbation of multiple sclerosis. Regional and global function of both ventricles was estimated using two-dimensional speckle tracking strain echocardiography.

Elastic aortic properties in patients with X syndrome.

INTRODUCTION: Elastic properties of the aorta represent an important determinant of left ventricular function and coronary blood flow but there are few data about aortic stiffness in patients with X syndrome. AIM: To investigate the elastic aortic proprieties (aortic stiffness and distensibility) and arterial wall motion velocities as measured by tissue Doppler imaging (TDI) in patients with cardiac X syndrome. MATERIALS AND METHODS: Fifteen patients with X syndrome (typical chest pain and angiographically normal coronary arteries associated with a positive exercise test) were enrolled in the study. The control group consisted of 15 healthy patients. The aortic elastic indexes, namely distensibility (cm(2) dyne(-1)) and stiffness index (ß index) were calculated from M-mode echocardiographically-derived thoracic aortic diameters using accepted formulae, and TDI parameters were measured on the wall of the ascending aorta 3 cm above the aortic valve. Anterior wall aortic expansion velocity (S), early (E) and late (A) diastolic retraction velocity and peak systolic strain were determined. RESULTS: Aortic elastic proprieties were more impaired in the syndrome X group than in the control group. Aortic distensibility was significantly lower in the syndrome X group (3.2 ± 1.3 vs. 7.95 ± 4 cm(2) dyne(-1), p<0.001), while stiffness index was higher (7.3 ± 2.1 vs. 4.1 ± 1.6, p<0.001) than in the control group. Peak systolic (S) and diastolic waves (E and A waves) of the aortic wall TDI were similar in patients and controls (S wave: 5.7 ± 1.6 cm/s vs. 5.8 ± 1.6 cm/s, E wave: -4.8 ± 2.0 vs. -4.1 ± 2.0 cm/s; A wave: -4.32 ± 2.1 vs. -4.76 ± 1.8 cm/s) while tissue strain of the aortic wall was lower in patients with X syndrome than controls (-12.80 ± 7% vs. -22.3 ± 5.9%, p<0.00001). CONCLUSION: Deterioration in aortic elasticity properties in patients with cardiac syndrome X suggests that this disease may be a more generalised disturbance of the vasculature.

An unusual case of myocardial infarction.

Myocardial infarction may be the result of embolism of calcified material from the aortic valve or thrombotic formations adhering to the same. We report a case of late myocardial infarction secondary to embolization from a thrombus adherent to the aortic valve jutting out in the ostium of the left main coronary artery.

Nonbacterial thrombotic endocarditis in pancreatic cancer.

Nonbacterial thrombotic endocarditis (NBTE), known as marantic endocarditis, is a phenomenon due to hypercoagulability with a complex pathogenesis. Originally described by Ziegler, the lesions of NBTE were considered to be fibrin thrombi deposited on normal or superficially degenerated cardiac valves. Numerous reports have identified the relationship between NBTE and a variety of different inflammatory states, including chronic diseases like malignancy and autoimmune disease. NBTE is a serious manifestation of prothtombotic state that is characterized by the deposition of thrombi on previously undamaged heart valves in the absence of a bloodstream bacterial infection and by the increased frequency of arterial embolic events in patients with chronic debilitating diseases. Although hypercoagulability is often seen in patients with pancreatic cancer, NBTE has rarely been reported antemortem. We report a case of marantic endocarditis in patient with pancreatic cancer, in which neurological symptoms preceded the diagnosis of pancreatic cancer.

A case of iatrogenic severe mitral regurgitation.

Bromocriptine and cabergoline, ergot derived dopamine receptor agonists used to treat Parkinson's disease and prolactinomas, have been associated with increased risk of cardiac valve disease. Here we present a case of iatrogenic symptomatic severe mitral regurgitation due to these drugs.