Fram Georgi, Wang Dee D, Malette Kelly, Villablanca Pedro, Kang Guson, So Kent, Basir Mir B, Khan Arfaat, McKinnon John E, Zervos Marcus, O'Neill William W
Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, United States.
Section of Cardiac Electrophysiology, Henry Ford Health System, Detroit, Michigan, MI 48202, United States.
Curr Cardiol Rev. 2021;17(3):319-327. doi: 10.2174/1573403X16666201014144022.
Hydroxychloroquine has been used for rheumatological diseases for many decades and is considered a safe medication. With the COVID-19 outbreak, there has been an increase in reports associating cardiotoxicity with hydroxychloroquine. It is unclear if the cardiotoxic profile of hydroxychloroquine is previously underreported in the literature or is it a manifestation of COVID-19 and therapeutic interventions. This manuscript evaluates the incidence of cardiotoxicity associated with hydroxychloroquine prior to the onset of COVID-19.
PubMED, EMBASE, and Cochrane databases were searched for keywords derived from MeSH terms prior to April 9, 2020. Inclusion eligibility was based on appropriate reporting of cardiac conditions and study design.
A total of 69 articles were identified (58 case reports, 11 case series). The majority (84%) of patients were female, with a median age of 49.2 (range 16-92) years. 15 of 185 patients with cardiotoxic events were in the setting of acute intentional overdose. In acute overdose, the median ingestion was 17,857 ± 14,873 mg. 2 of 15 patients died after acute intoxication. In patients with long-term hydroxychloroquine use (10.5 ± 8.9 years), new onset systolic heart failure occurred in 54 of 155 patients (35%) with median cumulative ingestion of 1,493,800 ± 995,517 mg. The majority of patients improved with the withdrawal of hydroxychloroquine and standard therapy.
Millions of hydroxychloroquine doses are prescribed annually. Prior to the COVID-19 pandemic, cardiac complications attributed to hydroxychloroquine were uncommon. Further studies are needed to understand the impact of COVID-19 on the cardiovascular system to understand the presence or absence of potential medication interactions with hydroxychloroquine in this new pathophysiological state.
羟氯喹已用于治疗风湿性疾病数十年，被认为是一种安全的药物。随着新冠疫情的爆发，将心脏毒性与羟氯喹相关联的报告有所增加。目前尚不清楚羟氯喹的心脏毒性情况在以往文献中是否未得到充分报道，还是它是新冠病毒感染及治疗干预的一种表现。本手稿评估了新冠疫情爆发前与羟氯喹相关的心脏毒性发生率。
检索了截至2020年4月9日的PubMed、EMBASE和Cochrane数据库，使用从医学主题词中提取的关键词。纳入标准基于对心脏疾病的恰当报告及研究设计。
共识别出69篇文章（58篇病例报告，11篇病例系列）。大多数患者（84%）为女性，中位年龄为49.2岁（范围16 - 92岁）。185例发生心脏毒性事件的患者中有15例处于急性故意过量服药情况。在急性过量服药时，中位摄入量为17,857 ± 14,873毫克。15例患者中有2例在急性中毒后死亡。在长期使用羟氯喹（10.5 ± 8.9年）的患者中，155例患者中有54例（35%）出现新发收缩性心力衰竭，中位累积摄入量为1,493,800 ± 995,517毫克。大多数患者在停用羟氯喹并接受标准治疗后病情改善。
每年开出数百万剂羟氯喹。在新冠疫情大流行之前，归因于羟氯喹的心脏并发症并不常见。需要进一步研究以了解新冠病毒感染对心血管系统的影响，从而了解在这种新的病理生理状态下是否存在与羟氯喹的潜在药物相互作用。
