THU0276 HIGH HYDROXYCHLOROQUINE EXPOSURE IS ASSOCIATED WITH ABNORMAL STRAIN IMAGING IN LUPUS PATIENTS WITH END-STAGE RENAL DISEASE
Authors: A. Londono Jimenez, M. H. Mustehsan, J. Law, A. Valle, M. Salgado Guerrero, C. Taub, A. R. Broder
Journal: Annals of the Rheumatic Diseases (2020)

Background: Hydroxychloroquine (HCQ) cardiotoxicity remains an underrecognized condition. Diagnosis ultimately relies on invasive endomyocardial biopsy (EMB) and non-invasive screening methods are warranted. Strain imaging is a novel tool to detect early subclinical left ventricular (LV) dysfunction and may have a role in screening for HCQ cardiotoxicity (1). Strain measures systolic deformation indices that when decreased can predict cardiovascular outcomes more accurately than LV ejection fraction (2). Objectives: We assessed whether high HCQ cardiotoxicity risk is associated with a specific strain pattern in a group of patients with SLE and end-stage renal disease (ESRD). Methods: This was a retrospective study in a tertiary care center in New York on a group of patients with an established diagnosis of SLE, ESRD and cardiomyopathy on the index echocardiogram followed between years 2003 and 2019. The patients were stratified into two groups: high risk HCQ toxicity group was defined as either cumulative HCQ dose ≥1000g and/or an endomyocardial biopsy confirming HCQ toxicity. Low/moderate risk group was defined as a cumulative dose of HCQ &lt;1000g. Clinical, demographic, electrocardiographic and echocardiographic strain parameters were compared between the groups. Results: A total of 16 patients were included. Two patients had EMB consistent with HCQ induced toxicity and 3 patients had cumulative HCQ doses ≥1000g. There were no significant differences in the baseline demographic characteristics between the two groups. Compared to patients with low/moderate risk, patients in the high risk group had a lower heart rate at the time of the echocardiogram (69 vs 87 beats per minute, p=0.08) and a higher frequency of LV hypertrophy (40% vs 9.1%, p=0.2). Strain analysis showed that both groups had compromised LV global longitudinal strain (GLS) and global cross-sectional strain (GCS). However, compared to the low/moderate risk group, the high risk group had a weaker LV GLS (-12.3% vs -14.9%, p=0.27). Characteristics overall and stratified by HCQ risk group Characteristic Overall (n=16 ) Low/Moderate HCQ Risk(n=11 ) High HCQ Risk and/or Positive EMB (n=5 ) P value Demographics Age, years 47.5 (36.5,60.7) 50.0 (33.9,60.5) 42.5 (42.7,61.0) 0.95 Female, n(%) 14 (87.5) 9 (90) 5 (83.3) 0.99 Clinical Features SLE duration, years 7.4 (4.3,17.5) 5.5 (3.5,13.2) 15.6 (11.6,19.3) 0.15 HCQ cumulative dose, g 422.8 (224.2,422.8) 285.4 (110.8,523.6) 1140 (1006,1625.4) 0.005 HCQ therapy duration, years 3.4 (2.5, 8.9) 3.2 (1.5,5.1) 7.8 (6.8,11.6) 0.06 HCQ daily dose, mg/d 226 (200,394.9) 200 (179.4,253.7) 400 (389.8,400) 0.007 Hypertension, n (%) 14 (87.5) 10 (90.9) 4 (80.0) 0.99 Diabetes, n (%) 3 (18.8) 2 (18.8) 1 (20.0) 0.99 CAD, n (%) 3 (18.8) 2 (18.8) 1 (20) 0.99 Echocardiogram EF, % 55 (42.5,60) 55 (40,60) 55 (55,70) 0.45 LA size, cm 3.8 (3.4,4.3) 3.8 (3.4,4.2) 4.3 (3.4,4.9) 0.30 LVEDD, cm 4.9 (4.4, 5.5) 4.8 (4.2,5.5) 5.0 (4.9,5.4) 0.43 E/E’ 12.3 (8.8,16.3) 12 (8.8,14.9) 16.9 (4.9,21.8) 0.43 Moderate-severe LV hypertrophy, n(%) 3 (18.7) 1 (9.1) 2 (40.0) 0.20 Strain echocardiography GLS, % -13.9 (-16.7,-12.3) -14.9 (-16.7,-12.9) -12.3 (-15.4,-12.2) 0.27 Base/Apex Ratio 0.8 (0.7,0.9) 0.76 (0.68,0.86) 0.76 (0.66,0.83) 0.95 GCS, % -20.2 (-21.7,-17) -19.7 (-20.5,18.0) -21.7 (-23.9,-20.9) 0.16 RV GLS, % -20.19 (-22.1,-17.5) -20.2 (-22.3,-17.1) -19.8 (-22.1,-17.5) 0.99 Conclusion: We report an association of higher HCQ cardiotoxicity risk and impaired strain in a set of SLE ESRD patients. Standard echo measures did not differentiate between high and low/moderate risk patients. Although the findings did not reach statistical significance, given the small sample size, results are still suggestive of a possible utility of strain echocardiography for detection of early HCQ toxicity. References: [1]Buss SJ, et al. J Rheumatol. 2010;37(1):79-86 [2]Kalam K, et al. Heart. 2014;100(21):1673-80 Disclosure of Interests: None declared