Predictive factors for cardiac conduction abnormalities with hydroxychloroquine-containing combinations for COVID-19

Area of Science:

• Cardiology
• Infectious Diseases
• Pharmacology

Background:

• Hydroxychloroquine (HCQ) was investigated for COVID-19 treatment.
• QTc interval prolongation is a potential adverse effect of certain medications.
• Assessing risks associated with HCQ combinations is crucial.

Purpose of the Study:

• To evaluate the risk of QTc interval prolongation in COVID-19 patients treated with HCQ combinations.
• To identify predictors of QTc prolongation in this patient cohort.

Main Methods:

• A longitudinal, prospective cohort study of 105 adult patients.
• Patients received HCQ with azithromycin (AZM), and often lopinavir/ritonavir (LPV/r).
• Cardiac monitoring included QTc interval measurements; multivariable Cox regression identified predictors.

Main Results:

• 13% of patients experienced moderate-to-severe QTc prolongation, primarily between Days 3-5.
• No cases of torsades de pointes (TdP) arrhythmia or related death occurred.
• Predictors included comedications with TdP risk (HR=11.28), higher neutrophil-to-lymphocyte ratio (NLR) (HR=1.10), and elevated hs-cardiac troponin I (HR=4.09).

Conclusions:

• HCQ-based therapy for COVID-19, even with combinations, did not lead to TdP in this monitored group.
• Comedications, elevated NLR, and myocardial injury (troponin I) are significant risk factors for QTc prolongation.
• Close cardiac monitoring is essential for patients with these risk factors receiving HCQ therapy.