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Antimalarial-induced Cardiomyopathy in Systemic Lupus Erythematosus: As Rare as Considered?

Konstantinos Tselios1,2, Mery Deeb1,2, Dafna D Gladman1,2

  • 1From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.

The Journal of Rheumatology
|October 17, 2018
PubMed
Abstract

Insights

Antimalarial-induced cardiomyopathy (AMIC) is underrecognized in systemic lupus erythematosus (SLE) patients. Early diagnosis using biomarkers and imaging can improve outcomes and survival.

Area of Science:

  • Cardiology
  • Rheumatology
  • Toxicology

Background:

  • Antimalarials (AM) are standard treatment for systemic lupus erythematosus (SLE).
  • Retinal damage is a known AM adverse effect, but cardiac disease is rarely reported.
  • This study describes 8 patients with AM-induced cardiomyopathy (AMIC) in an SLE cohort.

Observation:

  • Eight female SLE patients (median age 62.5) were diagnosed with AMIC.
  • Diagnosis involved endomyocardial biopsy (EMB) and cardiac magnetic resonance imaging (cMRI).
  • Patients presented with cardiac hypertrophy, arrhythmias, and elevated cardiac biomarkers (cTnI, BNP, CK).

Findings:

  • EMB showed cardiomyocyte vacuolation and myelinoid inclusions.
  • cMRI revealed ventricular hypertrophy, atrial enlargement, and late gadolinium enhancement.
  • One patient died from heart failure; others improved after AM cessation with biomarker normalization.

Implications:

  • AMIC may be underdiagnosed, often misattributed to other causes.
  • Biomarkers (cTnI, BNP) and cMRI are crucial for early AMIC diagnosis.
  • Prompt diagnosis and AM cessation can enhance survival in SLE patients.
Keywords:
ANTIMALARIALSCARDIOMYOPATHYSYSTEMIC LUPUS ERYTHEMATOSUS

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