Poller Wolfgang, Haghikia Arash, Kasner Mario, Kaya Ziya, Bavendiek Udo, Wedemeier Heiner, Epple Hans-Jörg, Skurk Carsten, Landmesser Ulf
Department of Cardiology, CC11 Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
German Center for Cardiovascular Research (DZHK) Site Berlin, Berlin, Germany.
J Clin Transl Hepatol. 2018 Jun 28;6(2):161-167. doi: 10.14218/JCTH.2017.00057. Epub 2018 Jan 26.
Whereas statistical association of hepatitis C virus (HCV) infection with cardiomyopathy is long known, establishment of a causal relationship has not been achieved so far. Patients with advanced heart failure (HF) are mostly unable to tolerate interferon (IFN)-based treatment, resulting in limited experience regarding the possible pathogenic role of HCV in this patient group. HCV infection often triggers disease in a broad spectrum of extrahepatic organs, with innate immune and autoimmune pathogenic processes involved. The fact that worldwide more than 70 million patients are chronically infected with HCV illustrates the possible clinical impact arising if cardiomyopathies were induced or aggravated by HCV, resulting in progressive HF or severe arrhythmias. A novel path has been opened to finally resolve the long-standing question of cause-effect relationship between HCV infection and cardiac dysfunction, by the recent development of IFN-free, highly efficient, and well tolerable anti-HCV regimens. The new direct-acting antiviral (DAA) agents are highly virus-specific and lack unspecific side-effects upon cardiac function which have always confounded the interpretation of IFN treatment data. The actual frequency of unexplained HF in chronic HCV infection will be determined from a planned large-scale study. Whereas such patients probably constitute a rather small fraction of all those harboring HCV, they have major clinical relevance. It is not yet known which fraction of these patients will significantly benefit from HCV eradication, but this issue will be addressed now in a prospective study.
虽然丙型肝炎病毒（HCV）感染与心肌病的统计学关联早已为人所知，但迄今为止尚未确立因果关系。晚期心力衰竭（HF）患者大多无法耐受基于干扰素（IFN）的治疗，导致关于HCV在该患者群体中可能的致病作用的经验有限。HCV感染常引发广泛的肝外器官疾病，涉及先天免疫和自身免疫致病过程。全球有超过7000万患者慢性感染HCV，这一事实表明，如果HCV诱发或加重心肌病，导致进行性HF或严重心律失常，可能产生的临床影响。通过近期开发的无IFN、高效且耐受性良好的抗HCV方案，为最终解决HCV感染与心脏功能障碍之间长期存在的因果关系问题开辟了一条新途径。新型直接抗病毒（DAA）药物具有高度的病毒特异性，对心脏功能没有非特异性副作用，而这些副作用一直混淆着IFN治疗数据的解读。慢性HCV感染中不明原因HF的实际发生率将通过一项计划中的大规模研究来确定。虽然这类患者可能仅占所有HCV感染者的一小部分，但他们具有重大的临床意义。目前尚不清楚这些患者中有多大比例将从HCV根除中显著获益，但这一问题将在一项前瞻性研究中得到解决。
