Abstract
Aim. To study cardiac hemodynamic disorders in patients with chronic viral hepatitis (CVH) and evaluate the effectiveness of antiviral therapy (AVT).Material and methods. Seventy-nine patients with CVH (mean age, 38,6 years, disease duration, 4,7 years) were examined. The patients were divided into two groups: group 1 (n=42) — normal level of alanine aminotransferase (ALT), group 2 — ALT 3-10 times higher than normal (n=37). Fourteen patients with CVH underwent AVT. Control group consisted of 23 people. Doppler echocardiography was performed. Statistical processing was carried out using Statistica 10.0.Results. In patients with active hepatitis, atrial volume, end diastolic volume, left ventricular (LV) mass index, LV stroke volume increased, and the tricuspid (TC) annular systolic velocity decreased in comparison with the control and 1st groups. In patients with normal ALT levels, the left atrial volume index increased by 8% in comparison with control group. Concentric remodeling was the predominant variant of LV remodeling in patients with active hepatitis. In patients with active hepatitis, LV lateral wall, interventricular septal (IVS), and TC Em/Am ratio decreased. LV diastolic dysfunction was reported in 12 patients with active and 3 patients with inactive CVH. After AVT, left atrium (LA) volume, IVS thickness, LV mass decreased, while TC and mitral annular systolic velocity increased. The viral load has a relationship with mitral annular systolic velocity (r=0,91, p=0,001) and LV mass (r=0,64, p=0,05).Conclusion. In patients with active hepatitis, along with LV and LA dilatation and hypertrophy, a relative right atrial increase, a decrease in the right ventricular longitudinal systolic velocity, and the formation of biventricular diastolic dysfunction develop. In patients with inactive hepatitis, only the left atrial volume increased. The established correlations indicate possible LV damage. Antiviral therapy has a beneficial effect on the main structural and functional cardiac parameters.
Highlights
АЛТ — аланинаминотрансфераза, левого желудочка (ЛЖ) — левый желудочек, ЛП — левое предсердие, ПЖ — правый желудочек, межжелудочковой перегородки (МЖП) — межжелудочковая перегородка, противовирусной терапии (ПВТ) — противовирусная терапия, трикуспидального клапана (ТК) — трикуспидальный клапан, фиброзного кольца (ФК) — фиброзное кольцо, хроническим вирусным гепатитом (ХВГ) — хронический вирусный гепатит
In patients with active hepatitis, atrial volume, end diastolic volume, left ventricular (LV) mass index, LV stroke volume increased, and the tricuspid (TC) annular systolic velocity decreased in comparison with the control and 1st groups
У пациентов с активным гепатитом, наряду с дилатацией и гипертрофией левого желудочка (ЛЖ) и ЛП, развивается относительное увеличение правого предсердия, снижение продольной систолической скорости ПЖ, формирование диастолической дисфункции обоих желудочков сердца
Summary
АЛТ — аланинаминотрансфераза, ЛЖ — левый желудочек, ЛП — левое предсердие, ПЖ — правый желудочек, МЖП — межжелудочковая перегородка, ПВТ — противовирусная терапия, ТК — трикуспидальный клапан, ФК — фиброзное кольцо, ХВГ — хронический вирусный гепатит. М.н., профессор кафедры факультетской терапии, ORCID: 0000-0002-27413783, Говорин А. В. Кардиогемодинамические нарушения у больных хроническим активным вирусным гепатитом и эффективность противовирусной терапии.
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