Saleh Ahmed, Matsumori Akira, Negm Hany, Fouad Hany, Onsy Ahmed, Shalaby Mohammed, Hamdy Enas
Academy of Scientific Research and Technology, Cardiovascular and Ultrasonography Research Unit "CURU", Cairo, Egypt.
J Saudi Heart Assoc. 2011 Oct;23(4):217-23. doi: 10.1016/j.jsha.2011.04.005. Epub 2011 May 23.
Hepatitis C disease burden is substantially increasing in Egyptian community, it is estimated that prevalence of Hepatitis C virus (HCV) in Egyptian community reach 22% of total population. Recently there is a global alert of HCV cardiovascular complications.
To evaluate LV diastolic functions of HCV patients using tissue Doppler Imaging and NTPBNP.
30 HCV patients of 30 years, sex & BMI matched controls were evaluated by PCR, ECG, Echocardiography "conventional Doppler, pulsed wave tissue Doppler (PW-TD), strain rate imaging" & NTPBNP to assess LV diastolic functions. Mean age was 32.8 years ± 5.1 in HCV group, 29.8 years ± 6.6 in control group. Cardiovascular anomalies and predisposing factors were excluded.
HCV group has shown significant increase in QTc interval, significant statistical increase in A wave, deceleration time; (p < 0.05), highly significant decrease in tissue Doppler E a (p < 0.001), highly significant decrease in A a (p < 0.001), highly significant increased E/E a ratio (p value < 0.001), significant decrease in E a/A a ratio and significant increase in SRa (p < 0.05). NTPBNP levels showed highly significant increase with mean value 222 pg/ml ± 283 in HCV group and 32.7 pg/ml ± 21.2 in control group (p value < 0.001). The best cut-off value of NTPBNP to detect diastolic dysfunction in HCV group was 213 pg/ml. No statistical differences in SRe/SRa and E/SRe ratios were observed, however they had significant correlation with NTPBNP level and tissue Doppler parameters. The best cut-off value of E/SRe ratio to detect diastolic dysfunction in HCV group was 0.91, with 75% sensitivity and 100% specificity.
This data show the first direct evidence that HCV infection causes diastolic dysfunction without any other predisposing factors, probably due to chronic inflammatory reaction with mild fibrosis in the heart. Previous studies did not follow strict inclusion and exclusion criteria that confirm the independent role of HCV to cause diastolic dysfunction. Tissue Doppler was more sensitive to diagnose diastolic dysfunction than conventional Doppler.
丙型肝炎在埃及社区的疾病负担正在大幅增加，据估计埃及社区丙型肝炎病毒（HCV）的患病率达到总人口的22%。最近，全球对HCV心血管并发症发出了警报。
使用组织多普勒成像和N末端脑钠肽前体（NTPBNP）评估HCV患者的左心室舒张功能。
通过聚合酶链反应（PCR）、心电图、超声心动图（常规多普勒、脉冲波组织多普勒（PW-TD）、应变率成像）和NTPBNP对30例年龄、性别和体重指数（BMI）匹配的30岁HCV患者及对照组进行评估，以评估左心室舒张功能。HCV组的平均年龄为32.8岁±5.1岁，对照组为29.8岁±6.6岁。排除心血管异常和易感因素。
HCV组的QTc间期显著延长，A波、减速时间有显著统计学增加（p<0.05），组织多普勒E/a显著降低（p<0.001），A/a显著降低（p<0.001），E/E/a比值显著升高（p值<0.001），E/a/A/a比值显著降低，SRa显著升高（p<0.05）。NTPBNP水平显著升高，HCV组的平均值为222 pg/ml±283，对照组为32.7 pg/ml±21.2（p值<0.001）。HCV组检测舒张功能障碍的NTPBNP最佳截断值为213 pg/ml。未观察到SRe/SRa和E/SRe比值的统计学差异，但它们与NTPBNP水平和组织多普勒参数有显著相关性。HCV组检测舒张功能障碍的E/SRe比值最佳截断值为0.91，敏感性为75%，特异性为100%。
该数据首次直接证明HCV感染在无任何其他易感因素的情况下导致舒张功能障碍，可能是由于心脏的慢性炎症反应伴轻度纤维化。先前的研究未遵循严格的纳入和排除标准来证实HCV导致舒张功能障碍的独立作用。组织多普勒在诊断舒张功能障碍方面比传统多普勒更敏感。
