P1459: chronic hepatitis c virus infection is associated with an increased risk of cardiac complications in thalassemia major

Topic: 27. Thalassemias Background: Hepatitis C virus (HCV) infection is associated with a number of important extrahepatic manifestations. Aims: The aim of this multicentric study was to prospectively assess the relationship between HCV infection and cardiovascular complications in patients with thalassemia major (TM). Methods: We considered 1057 TM patients (539 females; 29.79±10.08 years) consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) project. Every 18±3 months the patients performed a Magnetic Resonance Imaging (MRI) scan for iron overload assessment by the T2* technique. Results: On the basis of the presence of HCV antibodies and RNA, a categorization in 4 groups was performed: negative patients (group 1a, N=460), patients who spontaneously cleared the virus in the first 6 months of infection (group 1b, N=242), patients who eradicated the virus after the treatment with antiviral therapy obtaining a sustained virological response (SVR) (group 2, N=102), and patients with chronic HCV infection (group 3, N=254). The absolute first MRI was the baseline for patients in groups 1a, 1b and 3 while for patients in group 2 the baseline was represented by the first MRI performed after the virus eradication. The follow-up date coincided with the date of the last available MRI. Mean age was significantly lower in group 1a than in all the other 3 groups and in both groups 1b and 3 than in group 2. Group 1a and 1b were considered as a unique group (group 1, no chronic HCV infection). A match 1:1 for age and sex with group 2 was performed. Forty-four (14.4%) patients had an active cardiovascular complication at the baseline: 10 heart failure (HF), 1 HF+hypokinetic arrhythmias, 3 HF+supraventricular arrhythmias, 3 myo/pericarditis, 24 supraverntricular arrhythmias, 1 ventricular and supraventricular arrhythmias, 2 ventricular arrhythmias. Frequency of cardiovascular complications was comparable among the three groups. Moreover, no difference was detected in hepatic and cardiac iron levels or biventricular function parameters. Only the 262 (85.6%) patients without an active cardiovascular complication were accounted for: 86 in group 1, 92 in group 2, and 84 in group 3. During a mean follow-up time of 65.18±39.46 months, 16 (6.1%) cardiovascular events were recorded: 5 HF, 10 supraventricular arrhythmias, and 1 ischemic stroke. Prevalence of cardiovascular diseases was 4.7% in group 1, 4.3% in group 2, and 9.5% in group 3. Mean time from the baseline MRI to the development of a cardiac complication was 40.95±24.77months. The chronic HCV group showed a significantly higher risk of cardiovascular complications than group 1 (HR=3.80, 95%CI=1.11-1.03; p=0.034). The Figure shows the Kaplan-Meier survival curve.Summary/Conclusion: In TM patients, chronic HCV infection is associated with a significantly higher risk of cardiovascular complications and should be analysed as a systemic disease. However, we failed to demonstrate a significant reduction in the risk for development of cardiovascular events following HCV clearance. This finding could be related to the fact that HCV infection, being involved in the development of cardiac fibrosis, could determine an irreversible damage. Keywords: beta thalassemia, Complications, Hepatitis C virus