Relation of hepatitis C and its severity assessed by PCR to the presence and severity of coronary artery disease assessed by syntax score

Background: Egypt has the highest prevalence rate of hepatitis C virus in the world, making it the most challenging public health problem facing the country. Cardiovascular disease continues to be the principal cause of death worldwide. Several studies have been conducted to confirm, or disprove, an independent association between HCV infection and atherosclerotic disorders, including coronary artery disease

Objective: the aim of this study was to assess the correlation between hepatitis C virus infection severity and extent of coronary artery disease

Patients and Methods: this prospective study was carried out in the Cardiovascular Diseases Unit in Ain Shams University Hospitals. This study involved sixty one patients with positive test for HCV antibodies

Results: PCR level was highly correlated to the absolute Syntax score [SS] and to the Syntax score group, yet it was not found to be significantly correlated to the presence of significant coronary lesion nor to the number of vessels affected. On the other hand SS was highly correlated to the presence of significant coronary lesion and to the number of vessels affected

relation between red cell distribution width [RDW] and coronary artery calcium score [CACS] in the diabetic patients undergoing coronary CT angiography

Background: red cell distribution width is a marker associated with increased mortality and morbidity in cardiac patients, however it's relation with coronary artery calcium score [CACS] is not well studied yet

Aim of the work: this study aimed to assess the relation between red cell distribution width [RDW] and coronary artery calcium score [CACS] in the diabetic patients undergoing coronary CT angiography

Patients and methods: this study was conducted on 60 patients presented for assessment of coronary artery disease [CAD] by coronary CT angiography and they were categorized into 2 groups, group [A] diabetics[30 patients],group[B]non-diabetics [30 patients], All patients included in this study were subjected to: History Taking, complete physical examination, multi-slice CT coronary angiography [MSCT] including calcium score[CACS], laboratory investigations including complete blood count [CBC] including RDW[SDandCV], serum calcium level[total and ionized], erythrocyte sedimentation rate [ESR], lipid profile

Results: higher RDW[SD] was associated with the presence of greater coronary complexity of CAD and higher calcium score. In our study total serum calcium and RDW [SD] were found to be independent predictors of high Ca score more than 100, while ionized calcium and systolic blood pressure[SBP] were independent predictors of high Calcium score more than 400. Cut off value of RDW to predict high calcium score [more than 100] was RDW[CV] more than 13.45 and RDW[SD] more than44.45, while Cut off value of RDW to predict high calcium score [more than 400] was RDW[SD] more than 45.1

Conclusions: a greater baseline RDW[SD] value was independently associated with the presence of a greater coronary complexity of CAD and higher calcium score

Pre-ejection mitral annular motion velocity responses to dobutamine infusion: a quantitative approach for assessment of myocardial viability

Dobutamine stress echocardiography [DSE] is widely used for detection of myocardial viability. The main limitation of DSE is its subjective interpretation. Assessment of mitral annular motion velocities with tissue Doppler imaging is a simple and quantitative measurement. To determine the relationship between myocardial viability and regional systolic mitral annular motion tissue Doppler velocities responses to dobutamine stress. Our study group included 42 patients with previous myocardial infarction referred for coronary angiography and revascularization. We did dobutamine stress tissue Doppler echocardiography [DSTDE] measuring velocities of pre-ejection wave [pre-Ej] and peak ejection wave [Ej] at rest and during low-dose dobutamine infusion. We did follow up echocardiography after 1 month. After exclusion of the normokinetic walls, we analyzed 196 walls. Using receiver operator characteristic ROC curves, the optimal cut-off value for viability assessment was an increase of 1.75cm/s in pre-ejection velocity during DSTDE [area under the curve 0.70, p<0.001]. On the other hand, the optimal cut-off value for viability assessment was an increase of 1.75cm/s in ejection velocity during DSTDE [area under the curve 0.613, p=0.01]. The sensitivity, specificity, and total accuracy of the DSTSE [pre-Ej] versus the gold standard for detection of myocardial viability were 66.15%, 67.94%, and 67.35%, respectively. The sensitivity, specificity, and total accuracy of the DTSE [Ej] were 56.92%, 64.12%, and 61.43%, respectively. There was a good correlation between the pre-Ej at 5 ug/kg/min dobutamine infusion and the pre-Ej after revascularization [r=0.64, p=0.01] while the correlation with the Ej was moderate [r=0.50, p=0.01]. Viable left ventricular myocardium could be identified easily and quantitatively with pre-ejection mitral annular velocity during dobutamine infusion. The pre-ejection wave during DSTDE showed greater sensitivity and specificity for the prediction of myocardial viability than the ejection wave

Assessment of cardiac involvement of hepatitis C virus; tissue Doppler imaging and NTproBNP study

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 and BMI matched controls were evaluated by PCR, ECG, Echocardiography "conventional Doppler, pulsed wave tissue Doppler [PW-TD], strain rate imaging" and 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 SR[a] [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