Ibrahim Mohamed Gamal, Sharafeldin Ahmed Abdelrahman, Mousa Nevine Ibrahim, Mousa Tarek Khairy, El Missiri Ahmed Mohamed
Cardiology Department, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt.
Department of Internal Medicine, Gastroenterology and Hepatology, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt.
Egypt Heart J. 2020 Feb 7;72(1):7. doi: 10.1186/s43044-020-0042-y.
Hepatitis C virus (HCV) infection is a major public health problem in Egypt. The use of direct-acting antivirals (DAAs) in such patients has been shown to be highly effective. The cardiac safety of such antivirals remains uncertain. This study aimed to assess the effect of the novel DAAs on corrected QT (QTc) interval and on cardiac function using trans-thoracic echocardiography.
This was a prospective cohort study performed on 100 patients suffering from chronic HCV infection. Patients were into two equal groups according to the presence of liver cirrhosis. The group without liver cirrhosis received a daily combination of sofosbuvir 400 mg and daclatasvir 60 mg for 12 weeks while that with liver cirrhosis (Child-Pugh score A or B) received a daily combination of sofosbuvir 400 mg, daclatasvir 60 mg, and ribavirin 600 mg for 12 weeks. Surface ECG and trans-thoracic echocardiography were performed prior to the start of treatment and after 12 weeks of treatment. At the end of treatment, no changes were observed in QTc interval in those with (p = 0.48) or without (p = 0.048) liver cirrhosis. In patients without liver cirrhosis, right ventricular global longitudinal strain (RV GLS) decreased from 22 (-30 to -17) to -21 (-27-18), p = 0.024. In patients with liver cirrhosis, lateral mitral E' velocity was reduced from 14.38 ± 3.59 to 13.62 ± 3.21 cm/s, p = 0.02 and indexed left atrial volume (LAVI) was increased from 25.96 ± 3.96 to 26.86 ± 4.12 ml/m, p = 0.032. There were no changes in both groups regarding left ventricular (LV) dimensions, ejection fraction, trans-mitral E/A ratio, E/E' ratio, deceleration time, right ventricular (RV) systolic pressure, mean pulmonary artery pressure, RV fractional area change, tricuspid annular plane systolic excursion, and LV GLS.
The current national protocol of HCV infection treatment with direct-acting antiviral agents used in Egyptian patients has a good cardiac safety profile. Such treatments have no effect on QTc interval, left and right ventricular functions except for a decrease in RV GLS in those with no liver cirrhosis and a reduction in lateral mitral E' velocity in those with liver cirrhosis both remained within the normal reference range.
丙型肝炎病毒（HCV）感染是埃及的一个主要公共卫生问题。在这类患者中使用直接抗病毒药物（DAAs）已被证明非常有效。此类抗病毒药物的心脏安全性仍不确定。本研究旨在使用经胸超声心动图评估新型DAAs对校正QT（QTc）间期和心脏功能的影响。
这是一项对100例慢性HCV感染患者进行的前瞻性队列研究。根据是否存在肝硬化将患者分为两组，每组人数相等。无肝硬化组患者每天服用400毫克索磷布韦和60毫克达卡他韦，持续12周；而肝硬化组（Child-Pugh评分A或B）患者每天服用400毫克索磷布韦、60毫克达卡他韦和600毫克利巴韦林，持续12周。在治疗开始前和治疗12周后进行体表心电图和经胸超声心动图检查。治疗结束时，有肝硬化（p = 0.48）和无肝硬化（p = 0.048）的患者QTc间期均未观察到变化。在无肝硬化的患者中，右心室整体纵向应变（RV GLS）从22（-30至-17）降至-21（-27至-18），p = 0.024。在肝硬化患者中，二尖瓣外侧E'速度从14.38±3.59降至13.62±3.21 cm/s，p = 0.02，左心房容积指数（LAVI）从25.96±3.96增加至26.86±4.12 ml/m，p = 0.032。两组患者的左心室（LV）尺寸、射血分数、二尖瓣E/A比值、E/E'比值、减速时间、右心室（RV）收缩压、平均肺动脉压、RV面积变化分数、三尖瓣环平面收缩期位移和LV GLS均无变化。
埃及患者目前使用直接抗病毒药物治疗HCV感染的国家方案具有良好的心脏安全性。此类治疗对QTc间期、左心室和右心室功能无影响，除了无肝硬化患者的RV GLS降低以及肝硬化患者的二尖瓣外侧E'速度降低外，这些变化均仍在正常参考范围内。
