Background Hepatitis C virus (HCV) infection is a major public health problem in Egypt. The use of direct-acting antivirals (DAAs) in such patients has been shown to be highly effective. The cardiac safety of such antivirals remains uncertain. This study aimed to assess the effect of the novel DAAs on corrected QT (QTc) interval and on cardiac function using trans-thoracic echocardiography. Results This was a prospective cohort study performed on 100 patients suffering from chronic HCV infection. Patients were into two equal groups according to the presence of liver cirrhosis. The group without liver cirrhosis received a daily combination of sofosbuvir 400 mg and daclatasvir 60 mg for 12 weeks while that with liver cirrhosis (Child-Pugh score A or B) received a daily combination of sofosbuvir 400 mg, daclatasvir 60 mg, and ribavirin 600 mg for 12 weeks. Surface ECG and trans-thoracic echocardiography were performed prior to the start of treatment and after 12 weeks of treatment. At the end of treatment, no changes were observed in QTc interval in those with (p = 0.48) or without (p = 0.048) liver cirrhosis. In patients without liver cirrhosis, right ventricular global longitudinal strain (RV GLS) decreased from 22 (−30 to −17) to −21 (−27–18), p = 0.024. In patients with liver cirrhosis, lateral mitral E’ velocity was reduced from 14.38 ± 3.59 to 13.62 ± 3.21 cm/s, p = 0.02 and indexed left atrial volume (LAVI) was increased from 25.96 ± 3.96 to 26.86 ± 4.12 ml/m2, p = 0.032. There were no changes in both groups regarding left ventricular (LV) dimensions, ejection fraction, trans-mitral E/A ratio, E/E’ ratio, deceleration time, right ventricular (RV) systolic pressure, mean pulmonary artery pressure, RV fractional area change, tricuspid annular plane systolic excursion, and LV GLS. Conclusion The current national protocol of HCV infection treatment with direct-acting antiviral agents used in Egyptian patients has a good cardiac safety profile. Such treatments have no effect on QTc interval, left and right ventricular functions except for a decrease in RV GLS in those with no liver cirrhosis and a reduction in lateral mitral E’ velocity in those with liver cirrhosis both remained within the normal reference range.

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Background Coronary artery disease (CAD) is a widely prevalent disease with many adverse sequelae. As survival after myocardial infarction or coronary revascularization has improved, cardiac rehabilitation and secondary prevention services have become more important. Advances in ultrasound such as Doppler imaging, strain or strain rate imaging provide comprehensive information on left ventricle (LV) myocardial contractility. Objective to evaluate the possible early effect of intensive supervised Cardiac rehabilitation on the LV systolic and diastolic functions in patients with acute myocardial infarction (AMI) who had been successfully revascularized by primary percutaneous coronary intervention (PCI) using two dimensional (2D) speckle tracking and doppler imaging. Patients and Methods thirty patients with AMI and successfully revascularized by primary PCI were enrolled in the study. LV global longitudinal strain (LVGLS) analysis was performed using 2D speckle tracking echocardiography before and after Cardiac rehabilitation. LV ejection fraction (EF) was measured using the modified Simpson’s method. Pulsed-wave Doppler at the tip of mitral valve leaflets was also done allowing us to measure the early (E) and late (A) diastolic filling velocities, E/A ratio. The LV tissue velocity was measured by TDI of the lateral mitral annulus (e’) and E/e’ was calculated and LV diastolic dysfunction (DD) grade was estimated. Results There was significant improvement in LVEF measurements before and after Cardiac rehabilitation (47.50 ± 6.42 before vs. 52.17 ± 6.64 after; p = 0.000).The improvement in 2D speckle tracking LVGLS after Cardiac rehabilitation was statistically significant (p = 0.000). the diastolic function as assessed by TDI after a 3-month program of exercise-based cardiac rehabilitation has improved with decrease in the number of patients with DD grade I and increase in the number of normal diastolic function with p-value P < 0.01(highly significant). Conclusion cardiac rehabilitation has beneficial effects on LVGLS, LVEF as well as diastolic function after AMI and successful revascularization.