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Introduction: One hundred and seventy million individuals are infected with hepatitis C virus "HCV" worldwide. HCV infection might be associated with myocarditis, hypertrophic or dilated cardiomyopathy & even increased risk for coronary heart diseases. Our previous studies had proved the development of left ventricular diastolic dysfunction in HCV patients.Aim of work: To assess the left atrial performance in hepatitis C patients using combined Tissue Doppler imagining and biomarker approach.Methodology: Three hundred fifty individuals were screened for HCV antibodies using HCV antibody quick test and then underwent full physical examination, ECG and conventional transthoracic echo Doppler study. Ninety individuals screened subjects were randomly enrolled in two groups.Forty five HCV positive patients with 45 matched controls were evaluated to assess left atrial ejection fraction, ejection force and ejection time. LA tissue Doppler velocities & strain rate were estimated. N Terminal pro Brain Natriuretic Peptide level in plasma was also measured. Cases with risk factors or evidence of other cardiovascular disorders together with hepatitis B cases or those under interferon or cardiovascular therapy, Smokers, obese patients and patients over 40 years old were all excluded.Results: Highly significant increase in NTproBNP in HCV patients had been associated with significant increase in left atrial ejection fraction; p<0.05, ejection time; p<0.05, ejection force; p<0.05, highly significant increase in strain rate A; p<0.0001 and significant increase of left atrial tissue Doppler Va velocity; p<0.05. Subgroup comparisons had proved highly significant increase in left atrial ejection fraction, ejection time and ejection force together with significant increase in strain rate A in HCV patients with high levels of NTBNP when compared to hepatitis C patients with normal NTBNP.Conclusion: -Cardiac jeopardy in HCV patients might be related to intra-chamber pressure.– Periodic assessment of HCV patients by conventional, tissue Doppler and NTBNP might predict the critical point when left atrial pump performance decreases in spite of increased left ventricular preload due to myopathy or overstretch leading to loss of atrial contribution to ventricular filling.– HCV patients with high plasma level of NT pro-BNP are more prone to develop cardiac dysfunction than those with normal plasma level of NT pro-BNP.