Possible relationship between hydroxychloroquine and electrocardiographic and echocardiographic abnormalities in patients with inflammatory rheumatic diseases––a monocentric study. (March 2023)

• Record Type: Journal Article
• Authors: Pinheiro, Filipe Oliveira; Martins Carvalho, Miguel; Madureira, Pedro; Seabra Rato, Maria; Macedo, Filipe; Costa, Lúcia
• Is Part Of: Lupus. Volume 32:Number 3(2023)
• Page Start: 388
• Page End: 393
• Publication Date: 2023-03
• Subjects: autoimmune diseases -- echocardiography -- electrocardiography -- hydroxychloroquine -- heart; Systemic lupus erythematosus -- Periodicals; 616.772005
• DOI: 10.1177/09612033221149875
• Languages: English
• ISSNs: 0961-2033

Abstract

Objective: Hydroxychloroquine (HCQ) is used in the treatment of inflammatory rheumatic diseases and is considered a safe drug. The role of HCQ in the COVID-19 pandemic highlighted some deleterious cardiac effects of HCQ. We aim to evaluate the prevalence and development of cardiac-adverse events in HCQ-treated patients with inflammatory rheumatic diseases. Methods: We performed a cross-sectional study where patients aged ≥18 years with a diagnosis of inflammatory rheumatic disease currently exposed or not to hydroxychloroquine underwent electrocardiogram (ECG) and echocardiogram. Comparisons between groups were evaluated using chi-square, t test, and Mann-Whitney U test. Logistic regression was performed to determine predictors of changes in ECG and echocardiography. Results: Eighty patients were included, 75 (93.8%) female, aged 52 ± 13 years. ECG changes were seen in higher proportion in patients with hypertension (40.6% vs 12.5%, p = .004) and higher median potassium levels—4.5 (4.1–4.8) versus 4.2 (4.0–4.4), p = .023. Echocardiography changes were seen in older patients (59 ± 11 vs 50 ± 13 years, p = .003) and in patients with higher cumulative dose—1752 (785–2190) versus 438 (328–1022) g, p = 0.008 – and time of exposure to HCQ – 12 (6–15) versus 4 (2–9) years, p = 0.028. HCQ cumulative dose (OR 1.001, CI95% 1.000–1.002, p = .033) and exposure time (OR 1.136, CI95% 1.000–1.289, p = .049) were predictors of echocardiography changes, but when adjusted for age, neither HCQ cumulative dose nor exposure time were predictors of echocardiography changes. Conclusion: No association was found between changes in ECG and echocardiogram in patients under HCQ, which remains a safe drug in patients with inflammatory rheumatic diseases.