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Assessment of interferon cardiotoxicity with quantitative radionuclide angiocardiography
M Sartori1, S Andorno, G La Terra
1Dipartimento di Scienze Biomediche ed Oncologia Umana, Università di Torino, Novara, Italy.
Insights
Interferon therapy for chronic viral hepatitis can decrease left ventricular ejection fraction (LVEF), a key measure of heart function. Careful cardiac evaluation is recommended before initiating interferon treatment.
Area of Science:
- Cardiology
- Hepatology
- Pharmacology
Background:
- Interferon therapy is associated with cardiovascular complications, including arrhythmia, ischemic heart disease, and cardiomyopathy.
- The impact of interferon on cardiac function, specifically left ventricular ejection fraction (LVEF), requires further investigation in patients with chronic viral hepatitis.
Purpose of the Study:
- To evaluate changes in left ventricular ejection fraction (LVEF) during alpha interferon therapy in patients with chronic viral hepatitis.
- To assess the reversibility of any observed LVEF changes after cessation of interferon treatment.
Main Methods:
- Left ventricular ejection fraction (LVEF) was monitored in 11 patients with chronic viral hepatitis receiving subcutaneous alpha interferon therapy (3 MU three times weekly for 6 months).
- Cardiac function was assessed before, during (after 1 month), and after therapy completion (3 months post-treatment).
Main Results:
- A statistically significant decrease in mean LVEF was observed after 1 month of interferon therapy (P = 0.015).
- Five out of 11 patients experienced an LVEF reduction exceeding 10%.
- LVEF levels largely returned to pre-treatment values in most patients within 3 months after stopping therapy.
Conclusions:
- Low-dose subcutaneous interferon alpha therapy can reduce LVEF in patients with chronic C hepatitis.
- The exact mechanism (direct cardiac effect or vascular effects) of interferon-induced LVEF reduction remains unclear.
- Pre-treatment cardiac assessment is crucial, especially for patients with pre-existing myocardial contractility issues, due to the potential critical impact of LVEF reduction.
Abstract:
Three different types of cardiovascular sequelae attributed to interferon therapy have been reported: arrhythmia, ischaemic heart disease and cardiomyopathy. We evaluated the left ventricular ejection fraction (LVEF) during alpha interferon therapy (3 MU administered subcutaneously three times a week for 6 months) in 11 patients with chronic viral hepatitis. LVEF was within the normal range in all patients (mean value +/- SD 64.6 +/- 10.7%) before interferon was started, but decreased after 1 month of therapy (mean value +/- SD 59.7 +/- 8.3%) (P = 0.015). An LVEF reduction of more than 10% was observed in five of the 11 patients. Three months after therapy was stopped, nine of the 11 patients showed an LVEF close to the pre-treatment level (mean value +/- SD 62.1 +/- 8.3%). In our patients with chronic C hepatitis, low subcutaneous doses of interferon alpha often decreased the LVEF. It is not clear whether this finding is due to the direct effect of interferon on cardiac cells, or to the peripheral vascular effects of the drug. As LVEF reduction could be critical in patients with previously reduced myocardial contractility, our results further highlight the need for careful cardiac analysis before starting interferon therapy.