Left ventricular global longitudinal strain impairment during long-term hydroxychloroquine exposure

Area of Science:

• Cardiology
• Rheumatology
• Pharmacology

Background:

• Antimalarial-induced cardiomyopathy (AMIC) is a severe, under-recognized complication.
• Cardiac screening is not standard practice, unlike ocular toxicity screening.

Purpose of the Study:

• To investigate the association between chronic hydroxychloroquine (HCQ) intake and echocardiographic parameters in asymptomatic patients.
• To identify early markers for potential cardiac damage.

Main Methods:

• Retrospective analysis of 82 asymptomatic patients on HCQ, divided into tertiles based on exposure duration.
• Exclusion of patients with pre-existing heart conditions.
• Assessment of global longitudinal strain (GLS), left ventricular ejection fraction (LVEF), mass, and diastolic function.

Main Results:

• Significant differences in GLS were observed across HCQ exposure duration tertiles (p=0.048).
• GLS correlated significantly with HCQ exposure duration and cumulative dose (p<0.001).
• A HCQ dose threshold of 1994g showed 78.6% sensitivity and 76.5% specificity for impaired GLS.

Conclusions:

• Long-term HCQ use is associated with subclinical systolic dysfunction detected by GLS.
• GLS may serve as a valuable tool for early screening of AMIC in at-risk patients.
• Early detection of AMIC is crucial due to its poor prognosis.