Antimalarial-induced Cardiomyopathy in Systemic Lupus Erythematosus: As Rare as Considered?
Autor: | Susanna Mak, Dafna D. Gladman, Paula J. Harvey, Jagdish Butany, Mery Deeb, Shadi Akhtari, Murray B. Urowitz, Konstantinos Tselios |
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Rok vydání: | 2018 |
Předmět: |
030203 arthritis & rheumatology
medicine.medical_specialty Systemic lupus erythematosus Atrial enlargement medicine.diagnostic_test Heart disease business.industry Immunology Cardiomyopathy medicine.disease Brain natriuretic peptide 03 medical and health sciences 0302 clinical medicine Rheumatology Cardiac magnetic resonance imaging Ventricular hypertrophy Heart failure Internal medicine medicine Cardiology Immunology and Allergy 030212 general & internal medicine medicine.symptom business |
Zdroj: | The Journal of Rheumatology. 46:391-396 |
ISSN: | 1499-2752 0315-162X |
Popis: | Objective.Antimalarials (AM) are recommended for all systemic lupus erythematosus (SLE) patients without specific contraindications. Their main adverse effect is retinal damage; however, heart disease has been described in isolated cases. The aim of our study is to describe 8 patients with AM-induced cardiomyopathy (AMIC) in a defined SLE cohort.Methods.Patients attending the Toronto Lupus Clinic and diagnosed with definite (based on endomyocardial biopsy; EMB) and possible AMIC were included [based on cardiac magnetic resonance imaging (cMRI) and other investigations].Results.Eight female patients (median age 62.5 yrs, disease duration 35 yrs, AM use duration 22 yrs) were diagnosed with AMIC in the past 2 years. Diagnosis was based on EMB in 3 (extensive cardiomyocyte vacuolation, intracytoplasmic myelinoid, and curvilinear bodies). In 4 patients, cMRI was highly suggestive of AMIC (ventricular hypertrophy and/or atrial enlargement and late gadolinium enhancement in a nonvascular pattern). Another patient was diagnosed with complete atrioventricular block, left ventricular and septal hypertrophy, along with concomitant ocular toxicity. All patients had abnormal cardiac troponin I (cTnI) and brain natriuretic peptide (BNP), whereas 7/8 also had chronically elevated creatine phosphokinase. During followup, 1 patient died from refractory heart failure. In the remaining patients, hypertrophy regression and a steady decrease of heart biomarkers were observed after AM cessation.Conclusion.Once considered extremely rare, AMIC seems to be underrecognized, probably because of the false attribution of heart failure or hypertrophy to other causes. Certain biomarkers (cTnI, BNP) and imaging findings may lead to early diagnosis and enhance survival. |
Databáze: | OpenAIRE |
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