Diagnosis of Chloroquine Cardiomyopathy by Endomyocardial Biopsy

Ratliff, Norman B.; Estes, Melinda L.; Myles, Jonathan; Shirey, Earl K.; McMahon, James T.

doi:10.1056/nejm198701223160405

Cited by 110 publications

(71 citation statements)

References 9 publications

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“…22,23 Prognosis in antimalarial cardiotoxicity can vary from death to cardiac transplantation to partial or complete improvement in cardiac function. 5,7,8,10,11,[13][14][15][16][17][18][19][20][24][25][26] Two case reports have described successful orthotopic heart transplantation. 7,10 Indication in both cases was refractory congestive heart failure 3 months after drug discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

Joyce

Fabre

Mahon

2012

European Heart Journal: Acute Cardiovascular Care

138

126

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Cardiotoxicity is a rare but serious complication of hydroxychloroquine, a 4-aminoquinoline increasingly used in the treatment of rheumatological disorders. We describe typical clinical, echocardiographic, and histological features of this rare condition according to the currently available literature, illustrated with a recent new biopsy-proven case of hydroxychloroquine cardiotoxicity in a 52-year-old female with rheumatoid arthritis. Presentation in this case was of a rapidly progressive decompensated biventricular cardiomyopathy associated with recurrent biomarker elevations, conduction system disease, and possibly neuromyotoxicity. Death occurred suddenly 2 months after diagnosis despite drug discontinuation and clinical improvement. The potential role of cardiac magnetic resonance delayed gadolinium enhancement imaging in the prognosis of this toxic cardiomyopathy is also introduced. This case-based literature review highlights that, although rare, hydroxychloroquine cardiotoxicity can be fatal, particularly if irreversible histopathological changes have occurred prior to drug discontinuation. Given this, regular screening with 12-lead electrocardiography and transthoracic echocardiography to detect conduction system disease and/or biventricular morphological or functional changes should be considered in hydroxychloroquine-treated patients in addition to recommended ophthalmological screening.

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Section: Discussionmentioning

confidence: 99%

Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

Joyce

Fabre

Mahon

2012

European Heart Journal: Acute Cardiovascular Care

138

126

View full text Add to dashboard Cite

show abstract

“…Various drugs and chemicals have been associated with toxic cardiomyopathy, including anthracycline antibiotics (doxorubicin, daunomycin) (22)(23)(24)(25), cyclophosphamide (26), azidothymidine (27,28), chloroquine (29,30), alcohol (31), amphetamines (32), cocaine (33,34), and cobalt Environmental Health Perspectives 196 *** 9. .9* 9 A d * (35).…”

Section: Discussionmentioning

confidence: 99%

Cardiac Damage Induced by 2-Amino-3-methylimidazo[4,5-f]quinoline in Nonhuman Primates

Thorgeirsson¹,

Farb²,

Virmani³

et al. 1994

Environmental Health Perspectives

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The heterocyclic aromatic amine 2-amino-3-methylimidazo[4,5-f]quinoline (IQ) is a potent hepatocarcinogen in cynomolgus and rhesus monkeys. The finding of high cardiac IQ-DNA adduct levels prompted a histopathological study of perfusion-fixed hearts from 10 tumor-bearing monkeys chronically dosed with IQ at 10 mg/kg or 20 mg/kg 5 days per week for 48-80 months. Two monkeys dosed only with the vehicle for IQ, hydroxypropylcellulose, served as controls. All the monkeys had normal heart weights, and no abnormalities were observed upon gross inspection of the hearts. Microscopically, focal myocardial lesions were observed in 8 of 10 monkeys dosed with IQ. Light microscopic abnormalities included myocyte necrosis with or without chronic inflammatory infiltrates, interstitial fibrosis with myocyte hypertrophy or atrophy, and vasculitis. Electron microscopic findings included disruption of the mitochondrial architecture (i.e., mitochondrial swelling and clearing of matrix densities), myofibrillar loss, disorganization of the normal alignment of sarcomeres, and occasional myocytes showing nuclear hypertrophy or peripheral clumping of the nuclear chromatin. There was some correlation between the cumulative dose of IQ and the extent of the myocardial abnormalities. These findings suggest that chronic exposure to IQ can lead to myocardial damage in monkeys. Although focal and not associated with clinical evidence of heart failure, these abnormalities may represent the initial stages of IQ-induced toxic cardiomyopathy. Images Figure 1. A Figure 1. B Figure 1. C Figure 1. D Figure 2. A Figure 2. B Figure 3. A Figure 3. B Figure 3. C Figure 3. D Figure 4. A Figure 4. B Figure 5. A Figure 5. B

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“…To date, reports have been published on 35 patients with biopsy-proven cardiomyopathy 7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36 and on 30 patients with total AV block only 9,30,37,38 . Moreover, 12 of those patients with cardiomyopathy exhibited complete AV block as well (Table 1).…”

Section: Rheumatologymentioning

confidence: 99%

Cardiomyopathy Caused by Longterm Treatment with Chloroquine: A Rare Disease, or a Rare Diagnosis?

Tönnesmann¹,

Stroehmann²,

Kandolf³

et al. 2012

J Rheumatol

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Diagnosis of Chloroquine Cardiomyopathy by Endomyocardial Biopsy

Cited by 110 publications

References 9 publications

Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

Cardiac Damage Induced by 2-Amino-3-methylimidazo[4,5-f]quinoline in Nonhuman Primates

Cardiomyopathy Caused by Longterm Treatment with Chloroquine: A Rare Disease, or a Rare Diagnosis?

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