Assessment of cardiac involvement of hepatitis C virus; tissue Doppler imaging and NTproBNP study
Assessment of cardiac involvement of hepatitis C virus; tissue Doppler imaging and NTproBNP study
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DOI：
10.1016/j.jsha.2011.04.005
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发表时间：
2011-10-01
影响因子：
0.8
通讯作者：
Hamdy, Enas
中科院分区：
文献类型：
--
作者：
Saleh, Ahmed;Matsumori, Akira;Hamdy, Enas
简介：埃及社区的丙型肝炎疾病负担大幅增加，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，HCV心血管并发症引起了全球警报。目的：方法：30例年龄30岁的HCV患者，采用PCR、ECG、超声心动图常规多普勒、脉冲组织多普勒（PW-TD）、应变率成像及NTPBNP等方法评价左室舒张功能。HCV组的平均年龄为32.8 ± 5.1岁，对照组为29.8 ± 6.6岁。结果：HCV组QTc间期明显延长，A波、减速时间明显延长;（p < 0.05），组织多普勒Ea显著降低（p < 0.001），Aa显著降低（p < 0.001），E/Ea比值高度显著增加（p值< 0.001），Ea/Aa比值显著降低，SRa显著增加（p < 0.05）。NTPBNP水平显示出非常显著的增加，HCV组的平均值为222 pg/ml +/-283，对照组的平均值为32.7 pg/ml +/-21.2（p值< 0.001）。NTPBNP检测HCV组舒张功能障碍的最佳临界值为213 pg/ml。SRe/SRa和E/SRe比值与NTPBNP水平和组织多普勒参数相关，差异无统计学意义。E/SRe比值检测HCV组舒张功能障碍的最佳截止值为0.91，敏感性为75%，特异性为100%.Conclusion and recommendation：该数据显示了HCV感染导致舒张功能障碍的第一个直接证据，而没有任何其他诱发因素，可能是由于心脏中的慢性炎症反应和轻度纤维化。以前的研究没有遵循严格的纳入和排除标准，证实HCV引起舒张功能障碍的独立作用。组织多普勒对舒张功能不全的诊断较常规多普勒敏感。(C)2011年沙特国王大学。Elsevier B. V.制作和主持。保留所有权利。
Introduction: 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. Objective: To evaluate LV diastolic functions of HCV patients using tissue Doppler Imaging and NTPBNP.Methods: 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.Results: 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 Ea (p < 0.001), highly significant decrease in Aa (p < 0.001), highly significant increased E/Ea ratio (p value < 0.001), significant decrease in Ea/Aa 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.Conclusion and recommendation: 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. (C) 2011 King Saud University. Production and hosting by Elsevier B.V. All rights reserved.