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Value of 3D speckle tracking echocardiography in assessment of left ventricular (LV) systolic Dysfunction in hypertensive patients.( Azhar University)
Egypt (IFMSA-Egypt) - Azhar University, Cairo
Dr. Mohammed Zidan.
Dr. Mohammed Zidan.
Type of Research Project
- Clinical Project with Laboratory work
What is the background of the project?
It has been well established that one of the most important causes of coronary heart disease (CHD) and Cerebrovascular Disease (CVD) is hypertension; The heart involvement in arterial hypertension is currently evaluated by standard echocardiography. Measurements of left ventricular (LV) mass identify LV hypertrophy, whereas relative wall thickness categorizes LV concentric or eccentric (normal) geometry. LV hypertrophy is an independent predictor of morbidity and mortality and LV mass reduction induced by antihypertensive therapy improves the prognosis. However, the majority of studies in hypertensive cohorts uses measures of LV systolic function derived from standard 2D echocardiography and Doppler indices of LV diastolic function. An innovative evaluation of LV function has recently become available by two-dimensional (2D) speckle tracking echocardiography (STE), a non-Doppler technique that allows to quantify myocardial deformation in the different spatial directions. By this technique, longitudinal strain has been demonstrated to be the first component of systolic deformation to be modified in native hypertensive patients when the LV geometry is still normal but diastolic abnormalities are already detectable. Longitudinal strain is lower in hypertensive patients with than in those without LV hypertrophy. So We are going to use this new non invasive technology (real time three dimentional echocardiography Vivid E95 ultrasound machine (General Electric healthcare) in charachterizing early abnormalities of LV structure and Function in hypertensive patients. By this technology we will be able to treat them early and we will avoid the devastating complications of hypertention.
What is the aim of the project?
To determine the importance of 3D speckle tracking Electrocardiography (ECG) in detecting the early abnormalities in the Left Ventricular systolic function in hypertensive patients to treat them early.
What techniques and methods are used?
Hypertensive patients as well as Healthy Controls will be subjected to the following: A. Full medical history Patients will be subjected to detailed full history with special emphasis on: Functional capacity. Symptoms suggesting cardiac dysfunction (chest pain, dyspnoea, “paroxysmal Nocturnal Dyspnea (PND). B. Clinical examination including: General examination especially for signs of cardiac dysfunction and systemic diseases. Cardiovascular examination as primary assessment of cardiac function and exclusion of cardiac disease. D. Resting Electrocardiogram: Twelve leads ECG for signs of ischemia as pathological Q wave ST – T changes (normal, non-specific and non-significant ECG changes or signs of arrhythmia. E. Standard two-dimensional echo Doppler and real time three-dimensional echocardiography: 2D LV EF will be derived from LV end-diastolic and end-systolic volumes (average of the measurements in apical four- and two-chamber views) calculated according to the modified Simpson rule. LV mass will be calculated by 2D-guided M-mode imaging using the Devereux and Reichek formula and it will be indexed for height powered to 2.7 Left atrial volume (area-length method, average of measurements in apical four- and two-chamber views) will be indexed for body surface area. Trans mitral Doppler inflow and tissue pulsed Doppler will be recorded in the apical four-chamber view. The average of the peak early diastolic relaxation velocity (e′) of the septal and lateral mitral annulus will be computed and the ratio of the trans mitral peak early velocity (E) to average e′ (E/e′ ratio) will be calculated as a reliable estimate of invasively determined LV filling pressure. F. Real-time 3D echocardiography: The following data will be calculated 1. LV volumes and ejection fraction (EF), 2. Sphericity index, 3. LV mass index (LVMi), 4. Global longitudinal strain (GLS), 5. Global circumferential strain (GCS), 6. Global area strain (GAS), 7. Global radial strain (GRS).
What is the role of the student?
- The student will observe the practical experiments but will be highly involved in the analysis of the results
What are the tasks expected to be accomplished by the student?
1- Practice of learned skills: - General and local cardiac examination including - vital Signs (blood pressure, pulse, respiratory Rate) - head & neck examination - upper & lower limb examination - abdominal Examination - Resting surface 12 leads Electrocardiography (ECG) will be done for all patients. - Echocardiogram observation and possible involvement in some specific cases. 2-collecting patient history and data cross matching and analysis. 3-observation of the doctor and his work with the patients: - Doctor-patient relationship: - Taking patient history and the doctor will translate for the student in case of the patient does not speak English. - Bedside manners
Will there be any theoretical teaching provided (preliminary readings, lectures, courses, seminars etc)
Yes, There will be seminars to teach theoretical topics to the student according to his/her knowledge and illustration of any technique he doesn’t know about it. The seminars will be provided by dr. Mohamed Zidan
What is expected from the student at the end of the research exchange? What will be the general outcome of the student?
- The student will prepare a scientific report
What skills are required of the student? Is there any special knowledge or a certain level of studies needed?
1- previous study of cardiology and basic medical science. 2-Good level of English. 3- Basic background of ECG, ECO and Cardiac Ctheterization.
Are there any legal limitations in the student’s involvement
Type of students accepted
This project accepts: - Medical students - Graduated students (less than 6 months) - Pre-Medical students from the American-British system
- Clin Exp Hypertens. 2017;39(1):93-99. doi: 10.1080/10641963.2016.1210626. Epub 2017 Jan 10
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