Session Information
Date: Sunday, November 5, 2017
Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster I: Biomarkers and Outcomes
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Antimalarial (AM)-induced cardiomyopathy (AMIC) has been rarely reported in systemic lupus erythematosus (SLE). However, given the large number of patients treated, it seems possible that AMIC is under-recognized and may run undiagnosed as an ill-defined heart failure syndrome. Specific cardiac biomarkers may identify patients at risk. We sought to investigate the prevalence and associated factors for such biomarkers in systemic lupus erythematosus (SLE).
Methods: One hundred sixty eight consecutive patients (153 females) attending a large lupus clinic, without past history of cardiac disease (heart failure, coronary artery disease, valvulopathy etc.) and/or pulmonary hypertension, were enrolled. None had chest pain or electrocardiographic (ECG) abnormalities suggestive of acute coronary syndrome. High-sensitivity cardiac troponin I (cTnI) and B-natriuretic peptide (BNP) were measured simultaneously in serum and plasma samples, respectively. Patients were categorized according to normal or abnormal BNP and/or cTnI. For the assessment of the impact of AM duration on abnormal cardiac biomarkers, patients were divided in two groups according to the median duration of use, which was calculated at 5.6 years in the current cohort. Statistical analysis was performed with SAS 9.0 software; p<0.05 was considered significant.
Results: Sixteen patients (9.5%) had elevated BNP and/or cTnI. Compared to subjects with normal biomarkers, they were older, had longer disease and AM use duration and more frequently persistent creatine phosphokinase (CPK) elevation. Details are shown in Table 1.
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Table 1. Comparison between BNP/cTnI abnormal and BNP/cTnI normal patients |
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|
VARIABLE (At assessment) |
BNP/cTnI abnormal (no history of heart disease or PAH) (n=16) |
BNP/cTnI normal (n=152) |
P |
|
Age (y) |
54.7 ±15.1 |
47.83 ± 12.15 |
0.037 |
|
SLE duration (y) |
22.54 ± 10.44 |
15.45 ± 10.05 |
0.008 |
|
SLEDAI-2K |
1.88 ± 2.47 |
2.79 ± 3.64 |
0.329 |
|
Adjusted Mean SLEDAI-2K for 2 years prior |
2.52±2.96 |
3.02±3.18 |
0.549 |
|
eGFR < 30ml/min |
0 (0%) |
3 (2%) |
0.571 |
|
Hypertension |
10 (62.5%) |
54 (35.5%) |
0.035 |
|
Diuretics treatment |
5 (31.3%) |
8 (5.3%) |
<0.001 |
|
Systolic BP at test (mmHg) |
118.4 ± 21.7 |
113.5 ± 16.9 |
0.28 |
|
Diastolic BP at test (mmHg) |
71.9 ± 10.1 |
69.5 ± 11.8 |
0.444 |
|
Abnormal CPK ⌘ |
7 (43.8%) |
24 (15.8%) |
0.008 |
|
Cumulative years on AM |
13.66 ± 9.14 |
7.88 ± 8.02 |
0.008 |
|
AM duration>5.6 years |
14 (87.5%) |
69 (45.4%) |
0.001 |
|
Corticosteroids |
8 (50%) |
70 (46.1%) |
0.763 |
|
Mean prednisone (mg/day) |
9.4 ± 4.2 |
7.53 ± 5.1 |
0.326 |
|
Immunosuppressives |
10 (62.5%) |
87 (57.2%) |
0.685 |
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eGFR: estimated glomerular filtration rate, PAH: pulmonary arterial hypertension, BP: blood pressure, CPK: creatine phosphokinase, AM: antimalarials, CQ: chloroquine, HCQ: hydroxychloroquine, ⌘ Three abnormal measurements during the last two years |
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Multivariable regression analysis showed prolonged AM treatment (>5.6 years) and persistent CPK elevation to be important predictors for elevated cardiac biomarkers [HR=5.43, 95%CI=1.14-25.9, p=0.034 and HR=4.62, 95%CI=1.22-17.51, p=0.024, respectively]. Two patients were diagnosed with AMIC on endomyocardial biopsy; both had CPK and BNP/cTnI elevation.
Conclusion: Approximately 9% of SLE patients had elevated myocardial biomarkers, in the absence of prior cardiac disease or pulmonary arterial hypertension. Prolonged AM therapy and persistent CPK elevation conferred an increased risk for abnormal BNP and cTnI, which might predict AMIC.
To cite this abstract in AMA style:
Tselios K, Gladman DD, Harvey P, Akhtari S, Su J, Urowitz M. Prolonged Antimalarial Treatment Is Associated with Increased Risk for Elevated Myocardial Biomarkers in Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/prolonged-antimalarial-treatment-is-associated-with-increased-risk-for-elevated-myocardial-biomarkers-in-systemic-lupus-erythematosus/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/prolonged-antimalarial-treatment-is-associated-with-increased-risk-for-elevated-myocardial-biomarkers-in-systemic-lupus-erythematosus/