Hepatitis C virus-associated cardiomyopathy: A review of pathogenesis

Table 1 An overview of selected studies examining the link between hepatitis C virus infection and various forms of cardiomyopathy

Ref.	Year	Study type	Population studied	Key findings
Matsumori et al[77]	1995	Case-control/observational	36 patients with dilated cardiomyopathy vs 40 controls with ischemic heart disease (Japan)	Significantly higher HCV antibody prevalence (16.7% vs 2.5%) in patients with dilated cardiomyopathy. HCV RNA detected in the heart tissue of some patients
Omura et al[15]	2005	Animal study (transgenic mice)	Mice transgenic for the HCV-core gene vs wild-type mice	HCV-core gene expression led to cardiac dysfunction, hypertrophy, and fibrosis consistent with cardiomyopathy, suggesting a direct pathogenic role of the viral protein
Matsumori[78]	2005	Review/commentary	Review of studies (primarily Japanese) on patients with dilated cardiomyopathy, hypertrophic cardiomyopathy, myocarditis, and arrhythmogenic right ventricular cardiomyopathy	Summarizes evidence linking HCV to various cardiomyopathies. HCV antibodies were found in 10.6% of patients with hypertrophic cardiomyopathy and 6.3% of patients with dilated cardiomyopathy in a large Japanese study. HCV RNA found in the heart tissue
Dos Reis et al[79]	2006	Systematic review	Review of published studies on idiopathic dilated cardiomyopathy patients	The role of HCV in idiopathic dilated cardiomyopathy pathogenesis remains controversial. Significant association found in only 2 reviewed papers (same author, Japan); methodological limitations noted
Tsui et al[80]	2009	Cohort study analysis	Patients with stable coronary heart disease from the Heart and Soul Study	HCV-positive status is associated with higher tumor necrosis factor-α and increased risk of death and heart failure-related hospitalizations. HCV remained independently associated with heart failure events after adjustment
Younossi et al[81]	2013	Cross-sectional (NHANES)	United States population data (NHANES 1999–2010)	Chronic HCV is independently associated with insulin resistance, type 2 diabetes, hypertension, and congestive heart failure (but not ischemic heart disease or stroke)
Petta et al[9]	2015	Meta-analysis	22 observational studies comparing HCV-positive vs HCV-negative individuals	HCV infection is associated with increased cardiovascular disease-related mortality and subclinical carotid atherosclerosis
Poller et al[82]	2018	Review/perspective	General review focusing on chronic HCV, heart failure, and the impact of direct-acting antivirals	Known association between HCV and cardiomyopathy, but causality is unclear. HCV may aggravate existing heart issues via immune mechanisms. New direct-acting antivirals offer a way to study this

HCV: Hepatitis C virus.