Hepatitis C Virus Positivity Negatively Affects Cardiac Functions and Long-term Prognosis in Patients with Adult Congenital Heart Disease

Background: It was previously suggested that hepatitis C virus (HCV) positivity affects cardiac function. As the screening for HCV began in 1992 in Japan, we hypothesized that HCV positive rate would be higher in patients with adult congenital heart disease (ACHD) who underwent heart surgery before 1992, which would adversely affect cardiac functions and long-term prognosis in those patients. Methods and Results: We retrospectively examined 253 patients (median age, 20 years; M/F, 119/134) who were enrolled in our ACHD database between 1995 and 2010. Changes in cardiac functions were evaluated by both δleft ventricular ejection fraction (δLVEF, change from baseline LVEF) and δLVEF/year (δLVEF divided by follow-up year). Major adverse cardiac event (MACE) was defined as the composite of cardiac death, heart failure hospitalization, lethal ventricular arrhythmias, heart reoperation, and heart or pulmonary transplantation. HCV positivity was noted in 23 patients (9.1%) and all of them had undergone heart surgery before 1992. HCV-positive patients in the MACE-free group had greater reduction in LVEF; δLVEF (−22.5 ± 8.7 vs. −9.3 ± 11.5%, P = .0002) and δLVEF/year (−1.5 ± 0.7 vs. −0.8 ± 1.1%/year, P = .0066). Multivariate COX analysis showed that HCV positivity was a significant positive predictor of MACE (HR 2.21, 95% CI 1.02 to 4.39, P = .044). Conclusions: These findings suggest that more attention should be paid to HCV positivity in the management of ACHD patients.