Dilated cardiomyopathy induced by interferon therapy

Introduction: Cardiotoxicity due to interferon therapy, considered until recently the backbone of treatment in chronic hepatitis C, is rare, the most frequent cardiovascular complications being arrhythmias and reversible hypertension. Although cardiomyopathy as an adverse effect is cited in literature as extremely rare, it can be life threatening.
Objective: The purpose of this paper is to demonstra-te the importance of the echocardiographic evaluation before starting the treatment with interferon. Clinicians should be aware of this cardiovascular complication, requiring periodically monitoring of the cardiac function during treatment in order to reveal early adverse effects.
Case presentation: We are describing a case of a patient diagnosed with chronic hepatitis C, without a his-tory of cardiovascular disease before starting antiviral treatment with PEG-IFN α2B associated with Ribavirin, which developed shortly after the treatment initi-ation iatrogenic dilated cardiomyopathy. The diagnosis of severe heart disease was relatively late due to the in-terpretation of the symptomatology in the context of liver disease. As other adverse effects post-therapy with interferon, the patient associates autoimmune thyroiditis, anxiety and depressive disorder.
The reasons of which the patient attended the hospital was dyspnoea at rest and marked asthenia. Clini-cally, she has a BP of 110/70 mmHg, a HR of 110 bpm, frequent extrasystoles, gallop rhythm, 5/6 systolic mur-mur heard best in the tricuspid area and at the apex, with radiation to the axilla, diminished vesicular mur-mur at the base of lungs, without oedema of the lower limbs or ascites. The electrocardiogram shows sinus tachycardia 110 bpm, intermediate QRS axis, poor R wave progression from lead V1 to V5, 1 mm negative T wave in DII, DIII, aVF, P pulmonale, fragmented QRS complex. The transthoracic echocardiography reveals a dilated left ventricle (70 mm), thin, akinetic inter-ventricular septum (7 mm), moderate to severe mitral regurgitation, mild aortic regurgitation, moderate secondary pulmonary hypertension, severe diffuse LV hypokinesis with global EF 15%, the absence of pericardial effusion. The thoracic X-ray shows incalculable cardio-thoracic index, severe cardiomegaly, convex left middle arch, rounded costophrenic angles. Holter ECG monitoring objectifies frequent supraventricular and frequent polymorphic ventricular extrasystoles, isolated and systematized (ventricular bigeminy, couplets, 3 nonsustained ventricular tachycardia episodes). The index case associates a 12808 pg/ml NT-proBNP level, hepatic cytolysis, cholestasis and high coagulation time due to liver dysfunction, iron deficiency anemia.
Conclusions: T he particularity of this case is represented by dilated cardiomyopathy as an adverse effect of interferon therapy and its persistence long after the antiviral treatment has ceased. Although prognosis is reserved, immediate improvement has been favorable (after sacubitril/valsartan, diuretic, antiaggregant and antiarrhythmic therapy) by relieving symptoms, in-creasing exercise capacity, decreasing NT-proBNP level and slightly increasing the LV ejection fraction.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)