الفهرس 
Chapter 1 Coronary artery disease
Epidemiology of HCV in Egypt:Only 14 pages are availabe for public view
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Abstract
Coronary artery disease (CAD) is the main cause of death and morbidity, with impairment in quality of life.Moreover, CAD is a leading problem responsible for significant total health costs.
Chronic hepatitis C virus (HCV) is a leading cause of end‑stage liver disease that affects more than170 million individuals worldwide. In addition to causing progressive liver damage, HCV has a number of important extrahepatic manifestations including spectrum of cardiovascular diseases, like CAD.
Early studies reported that markers of HCV were independently associated with atherosclerosis. Atherosclerosis is a chronic inflammatory disease.
Many factors related to chronic HCV infection are thought to have a role to atherosclerosis. HCV infection stimulates the host immune response, activates T helper cells and releases pro-inflammatory cytokines such as interferon-alpha (IFN-α), interleukin-1 (IL-1),interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α).
The relationship between HCV and CAD is unclear, and previous studies have reported conflicting results.
The aim of the study was to assess the extent and severity of coronary artery disease in patients with hepatitis C virus undergoing coronary angiography
Methodology: This study enrolled 250 patients who underwent coronary angiogram for evaluation of coronary anatomy at catheterization unit in Menoufia University Hospital and Sohag Cardiac specialized Center after obtaining written approval from patients and hospital ethical
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committee. They distributed into groups; group A: (125) subjects sero-positive for HCV & without clinical liver disease.and group B: (125) subjects sero-negative for HCV (Control group).
Proper history was taken from all patients ,Clinical evaluation, Laboratory investigations, 12 Lead Electrocardiography and Echocardiography examination was preformed .
Coronary angiography was preformed then the number of affected vessels reported and Geneini score was calculated .
Results: more than two thirds of participants were males (77.6% and 68.8%) in sero positive group and sero negative group respectively ,The mean age and SD was (60.06 ± 7.58, 58.20 ± 10.98) in case and control groups respectively ,The mean and SD of BMI in seropositive group was 22.92 ± 5.52 and for seronegative group was 22.14 ± 2.86, with no statistically significant difference between both groups (P>0.05)
The related atherosclerosis risk factors DM (43.2% and 40%), HTN (64.8% and 65.6%) ,smoking (59.2% and 61.6%) and dyslipidemia(24.8% and 32.2%) in group A and group B respectively with no statistically significant difference between both groups (P>0.05)
ECG finding in two groups ;the AF found only in (6 patient in seropositive group and 14 patient in sero negative group , for old MI (13 and 14) and ST_T changes(88 and 94 ) of group A and group B respectively with no statistically significant difference between two groups
Assessment of systolic function showed the mean value of EF of the seropositive group was 61.57 with SD 6.05 and for seronegative group
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(61.84 with SD 6.71 . There is no statistically significant difference between both groups (P>0.05)
Regarding the segmental wall motion abnormalities SWMA, they were revealed in 76 (60.8%) of seropositive group and 75(60%) of seronegative group. There is no statistically significant difference between both groups (P>0.05)
Abnormal finding of angiography was represented more in seropositive group regarding (LMA, LAD, D1, LCX, OM1, OM2, RCA and PDA) but in D2 abnormal finding was 2 in each group and abnormal PL finding was found only in 2 patient in seronegative group, there is no statistically significant difference between both groups in all parameters (P>0.05)
The extension of vessels affected in both groups; in sero positive group multiple vessels defect found in 37 patients (29.6%) ,two vessels 26 patients (20.8%) and single vessel in 18 patients (14.4%),and in sero negative ;single vessel was found in 32 (25.6%) patients , multi vessels in 20(16%) and two vessels in 19(15.2%) patients ,with significant difference between both groups (P=0.011)
Significant difference between both groups (p=0.041) according to gensini score with higher score in sero positive group (36.02 ± 46.42) vs (23.42 ± 35.08) for seronegative group
Conclusion: We demonstrated a significant association between HCV infection and the severity of coronary atherosclerosis using Gensini score.