Chloroquine and hydroxychloroquine induced cardiomyopathy: A systematic review of literature

Introduction and objectives

Chloroquine (CQ) and hydroxychloroquine (HCQ), initially developed for malaria prophylaxis, are now widely used in rheumatic diseases, such as systemic lupus erythematosus and rheumatoid arthritis. Despite their therapeutic benefits, these drugs can induce cardiotoxicity, particularly cardiomyopathy. This systematic review evaluates the prevalence, clinical features, and diagnostic challenges of CQ/HCQ-induced cardiomyopathy.

Methods

A comprehensive literature search was conducted in PubMed, EMBASE, and Cochrane databases, identifying 60 studies reporting 79 cases of CQ/HCQ-induced cardiomyopathy. Inclusion criteria required histopathological confirmation via endomyocardial biopsy. Data on clinical presentations, diagnostic findings, and outcomes were extracted and analyzed.

Results

Patients were predominantly female (76%), with a median age of 56 years. The cardiomyopathies observed included hypertrophic, dilated, and restrictive forms, frequently presenting with heart failure and conduction disorders, such as atrioventricular block and arrhythmias. Cardiac magnetic resonance imaging and endomyocardial biopsy revealed characteristic toxicological changes, including myocyte vacuolization and fibrosis. Management often involved discontinuation of therapy, but severe cases progressed to cardiac transplantation or resulted in mortality (19%).

Conclusions

CQ/HCQ-induced cardiomyopathy is an underrecognized complication with significant morbidity and mortality. Early detection through continuous cardiac monitoring in patients on long-term CQ/HCQ therapy is crucial. Effective management, including timely drug discontinuation, may improve outcomes, although prognosis remains guarded in advanced stages.