Journal of Hepatology: "Myocardial injury in patients with chronic hepatitis C infection"

Abstract entitled "Myocardial injury in patients with chronic hepatitis C infection" posted online 8/13/12 in Journal of Hepatology.eu. A compelling study from Japan that definitely warrants further research into this phenomena and may add to the long list of extra-hepatic manifestations of having active, replicating Hepatitis C virus in the human body. This particular study found a link between myocardial perfusion and HCV.  Patients who achieved an SVR garnered better severity scores (SS) than prior to therapy. Relapsers saw improved SS scores while on therapy, but the scores worsened with the reappearance of virus.  If these results are confirmed, it adds to a growing base of evidence that dictates treating earlier instead of later. 

Article in Press

Myocardial injury in patients with chronic hepatitis C infection

Shigeo Maruyama, Masahiko Koda, Nobuyuki Oyake, Hidetoshi Sato, Yasuyoshi Fujii, Yutaka Horie, Yoshikazu Murawaki

Received 4 April 2012; received in revised form 13 July 2012; accepted 31 July 2012. published online 13 August 2012.

Accepted Manuscript

Abstract

Background & aims
The existence of a direct pathogenic link between hepatitis C virus (HCV) infection and myocardial injury has not been confirmed. We investigated the association between myocardial conditions and HCV in patients with HCV-related chronic hepatitis using thallium-201 myocardial scintigraphy.

Methods
In 217 consecutive cases of chronic HCV infection without overt heart disease, we performed electrocardiography (ECG), echocardiography, serum tests on myocardial injury and thallium-201 myocardial scintigraphy. Myocardial injury was confirmed by severity score (SS), which was calculated as the sum of thallium-201 perfusion defect scores. SS was followed prior to and after interferon (IFN) therapy in 200 patients with chronic hepatitis C.

Results
An abnormal ECG was found in 9% of the patients with chronic hepatitis C. Abnormal SS was found in 87% of chronic hepatitis C patients. Independent factors related to higher pretreatment SS were histology activity index score, serum HCV RNA titer and indocyanine green disappearance rate. After IFN therapy, SS was improved in patients with sustained virologic response. Among relapsers, the SS improved at the initial disappearance of HCV RNA, but SS worsened with reappearance of HCV RNA. The SS in non-viral responders did not change with IFN therapy.

Conclusions
Myocardial perfusion defects were found in 87% of the patients with chronic hepatitis C and improved with viral eradication from IFN therapy.