Left ventricular diastolic abnormalities and the impact of hepatitis C virus infection in multitransfused Egyptian children

Introduction: The aim of the study was to evaluate left ventricular cardiac systolic and diastolic functions by echocardiography in multitransfused children and the possible risk of hepatitis C virus infection as an additional factor impairing cardiac functions in these patients.
Material and methods: Echocardiographic studies of left ventricular function in 80 multitransfused patients aged 3 to 15 years with no clinical evidence of heart failure were included in our study. Anti-hepatitis C virus antibody was present in the sera of 25 of them. Twenty age and sex matched normal subjects were studied as a control.
Results: Results showed left ventricular systolic abnormalities in 15 cases (18%). Nine cases were HCV seropositive. Dilatation of left ventricle and impaired systolic function guided by FS (fractional shortening) was significantly reduced compared to normal subjects\' mean FS (p < 0.01). Systolic dysfunction is significantly observed in hepatitis C virus seropositive cases (mean FS 29 ±7.9 vs seronegative cases 31.4 ±10 (p < 0.035). Restrictive left ventricular diastolic abnormalities were detected in 45 patients (56.25%). Diastolic dysfunction was represented in prolonged isovolumic relaxation time in comparison to the control group (p < 0.03) and higher E wave (p < 0.001) also increased the ratio of early to late diastolic velocity (E/A ratio, 2.03 ±0.59 vs 1.6 ±0.27, p < 0.05). No significant difference in diastolic functions was found between HCV seropositive and seronegative groups. There is a weak negative correlation between left ventricular FS and serum ferritin level (r = 0.77, p < 0.001).
Conclusions: Multitransfused children are more liable to left ventricular diastolic dysfunction suggested by impaired relaxation probably due to iron overload and anaemia. Hepatitis C virus infection is an additional factor which might share in impairing left ventricular systolic function. Left ventricular performance is better preserved when chelation treatment is adjusted to maintain serum ferritin at <1000 ng/ml.