Download Rajiv Gandhi University Of Health Sciences, Karnataka Bangalore

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BANGALORE.
ANNEXURE- II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
NAME OF THE
CANDIDATE AND
ADDRESS
(IN BLOCK LETTERS)
DR.VINAY M DIPALI
2.
NAME OF THE
INSTITUTION
KARNATAKA INSTITUTE OF
MEDICAL SCIENCES,HUBLI-22.
3.
COURSE OF STUDY AND
SUBJECT
M.D. IN GENERAL MEDICINE.
4.
DATE OF ADMISSION TO
COURSE
5.
TITLE OF THE TOPIC
1.
6.
POST GRADUATE IN GENERAL MEDICINE,
KARNATAKA INSTITUTE OF
MEDICAL SCIENCES,
HUBLI-580022.
15-05-2009
CORRELATION OF ELECTROCARDIOGRAPHY AND
ECHOCARDIOGRAPHY IN PATIENTS WITH LEFT
VENTRICULAR HYPERTROPHY
BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR STUDY:
There is an increased risk of cardiac morbidity and mortality associated with left ventricular
hypertrophy (LVH), so its detection is of major importance, especially for individuals with
hypertension or other cardiovascular risk factors. LVH is no longer considered an adaptive process
that compensates the pressure imposed on the heart and has been identified as an independent and
significant risk factor for sudden death, acute myocardial infarction, and congestive heart failure.
The increase in left ventricular mass represents a common final pathway towards the adverse effects
on the cardiovascular system and higher vulnerability to complications.
Electrocardiographic evidence of left ventricular hypertrophy is one of the most widely used
markers of cardiovascular morbidity and mortality. It has become a clinical priority to precociously
detect left ventricular hypertrophy by effective, low-cost screening, applicable to the population in
general. ECG is relatively insensitive and cannot accurately quantitate the severity of LVH. Also
LVH is difficult to diagnose by ECG if left bundle branch block is present. Because of these
limitations, other diagnostic modalities have been used for LVH assessment. The most successful
and popular of these techniques has been echocardiography. Echocardiography has revolutionized
the diagnosis of LVH because echocardiographic evidence of LVH occurs in 30 to 40 percent of
hypertensive patients whose ECG and chest X-ray are normal.
6.2 REVIEW OF THE LITERATURE:
1) Mia M R, A R M Saifuddin Ekram , Haque M A,Raisuddin in their study of 100 cases in random
manner concluded that ECG is very sensitive (90%) but less specific (20- 60%) in diagnosing left
ventricular hypertrophy.They also found that out of 80 patients having ECG-LVH,
echocardiographic evidence of LVH was found in 70 of them. The specificity of ECG criteria in
this study was 50%, which is consistent with various other studies. Sensitivity of ECG in
comparison to Echocardiography was calculated to be 87.50% which is consistent with various
other studies. Sensitivity of ECG to diagnose LVH was found to be 87.5%, and specificity was only
50%. ECG is relatively insensitive and cannot accurately identify the severity of LVH.
2) Hameed W et al, in their study of fifty clinically diagnosed patients of LVH found that ECG
had a sensitivity of 35% and specificity 90% and they concluded that the sensitivity of ECG is low
in detecting LVH as compared to echocardiography. However the sensitivity of ECG to detect LVH
can be increased by adding Cornell Voltage criteria and Sokolow Lyons voltage criteria to RomhiltEstes pointscore system.
3) Okin P M et al,in their study of ECGs and echocardiograms of 2193 patients,Echo-LVH and
ECG-STD predicted CV(cardiovascular) and AC(all cause) mortality, respectively. The
combination of Echo-LVH and ECG-STD improved risk stratification compared with either alone
for both CV death and AC death , with presence of both ECG-STD and Echo-LVH associated with
the greatest risks. After adjustment for age, sex, and relevant risk factors, combined Echo-LVH and
ECG-STD remained predictive of CV mortality and AC mortality, with the presence of both EchoLVH and ECG-STD associated with a 6.3-fold increased risk of CV death (95% CI: 2.8 to 14.2) and
a 4.6-fold increased risk of AC mortality (95% CI: 2.5 to 8.5). ECG-STD and Echo-LVH additively
increase the risk of both CV mortality and AC mortality. Their findings supported the value of
combining
Echo-LVH and ECG-STD to improve risk stratification.
4) R. B. Devereux et al in their study of “Methods for detection of left ventricular hypertrophy:
Application to hypertensive heart disease” showed that the sensitivity of echocardiography to detect
LVH has been reasonably high (85–100%), whereas that of ECG has ranged from as high as 50% in
severely diseased necropsy populations to as low as 6–17% in recent studies in Cornell and
Framingham. ECG sensitivity can be improved by using Cornell multivariate regression equations
or by consideration of the Cornell voltage-QRS duration product. Obesity dramatically decreases
the sensitivity of the ECG for detection of LVH, and recent research suggests a lower specificity and
a higher rate of false-positive ECG diagnoses of LVH in black than in white subjects. Standard
criteria for ECG LVH are less useful than echocardiographic findings for stratifying populations
into high- and low-risk subgroups because of lower sensitivity.
5) N Reichek and RB Devereux studied the Anatomic, echocardiographic and ECG findings of
left ventricular hypertrophy (LVH) in 34 subjects. Echocardiographic LV mass correlated well
with postmortem LV weight (r = 0.96) and accurately diagnosed LVH (sensitivity 93%,
specificity 95%). In contrast, Romhilt-Estes (RE) point score and Sokolow-Lyon (SL) voltage
criteria for ECG LVH were insensitive (50% and 21%, respectively) but specific (both 95%). RE
correlated weakly with LV weight (r = 0.64), but SL did not.They concluded that the ECG is
specific but insensitive ill recognition of LVH. M-mode echocardiographic LV mass is superior to
ECG criteria for clinical diagnosis of LVH.
6.3 AIMS AND OBJECTIVES OF THE STUDY:
1. To determine the electrocardiographic and echocardiographic evidence of LVH.
2. 2. To correlate the electrocardiographic and echocardiographic evidence of LVH in
patients with various etiologies of LVH.
7.
MATERIALS AND METHODS :
7.1
SOURCE OF DATA:
A total of 100 patients from those attending medicine OPD and getting admitted
medicine ward,KIMS hospital,Hubli, during the period of
December 1st 2009 to November 30th
2010 will be taken for study considering the inclusion and exclusion criteria.
7.2
METHODS OF COLLECTION OF DATA:
1)Information will be collected through a pre tested and structured proforma for each
patient.
2)
Qualifying patients will be undergoing detailed history, clinical examination,12-lead
ECG and 2-Dechocardiography.
SAMPLE SIZE:A Total of 100 patients after considering inclusion and exclusion criteria
will be taken up for study.
TYPE OF STUDY:CROSS SECTIONAL HOSPITAL BASED TIME BOUND STUDY.
SAMPLING:As per hospital statistics 10000 patients were admitted in Department of
Medicine, KIMS, Hubli in the year 2008. Of them 900 patients were diagnosed to have
LVH. This gives a prevalence of 9% With confidence interval of 95% and 5% permissible
error, sample size comes out to be 100 cases. However this being a time bound study
(December 1st 2009 to 30th November 2010), all the patients presenting with LVH in
Medicine Department,KIMS Hospital during this period will be taken for the study.
Inclusion criteria :
All patients presenting to OPD and admitted in Medicine ward,KIMS Hospital
HUBLI,with history and Clinical profile suggestive of cardiac morbidities leading to LVH as
mentioned below and confirmed by 2-D echocardiography will be included in the study.
1)Essential Hypertension.
2)Mitral and Aortic Regurgitation,Aortic Stenosis.
3)Coarctation of aorta,VSD
Exclusion criteria:
-Ischemic Heart disease
-Bundle Branch Blocks
Parameters used:clinical profile, 12-lead ECG changes,2-D echo findings.
Statistical Analysis:percentages,proportions,chi-square,correlation.
7.3 Does the study require any investigations or interventions to be conducted on patients or
other humans or animals? (If so, please describe briefly)
Yes,
1) Routine blood investigations
2) ECG
3) 2-D ECHO
7.4 Has ethical clearance been obtained from ethical committee of your institution in case of
7.3?
Yes, ethical clearance has been obtained from the ethical committee KIMS, Hubli.
8.
LIST OF REFERENCES:
1) M Razzak Mia , A R M Saifuddin Ekram , M Azizul Haque , Raisuddin;
A Comparative Study of Electrocardiographic and Echocardiographic
Evidence of Left ventricular Hypertrophy; TAJ 2007; 20(1): 24-27.
2)Waqas Hameed et al,ELECTROCARDIOGRAPHIC DIAGNOSIS OF LEFT VENTRICULAR
HYPERTROPHY: COMPARISON WITH ECHOCARDIOGRAPHY; Pak J Physiol 2005;1(1-2).
3)Peter M. Okin et al, Combined Echocardiographic Left Ventricular Hypertrophy and
Electrocardiographic ST Depression Improve Prediction of Mortality in American Indians
The Strong Heart Study; Hypertension 2004;43;769-774;
4) R. B. Devereux et al,Methods for detection of left ventricular hypertrophy: Application to
hypertensive heart disease; European Heart Journal 1993 14(Supplement D):8-15;
5) N Reichek and RB Devereux;Left ventricular hypertrophy: relationship of anatomic,
echocardiographic and electrocardiographic findings;Circulation;1981;63;1391-1398.
9.
Signature of the candidate
10.
Remarks of the guide
11.
Name and Designation
11.1 Guide
DR.ISHWAR HASABI.
ASSOCIATE PROFESSOR,
DEPARTMENT OF MEDICINE
KIMS, HUBLI.
11.2 Signature
11.3 Co-Guide
11.4 Signature
11.5 Head of the Department
11.6 Signature
12.
12.1 Remarks of the Principal
and Chairman
12.2 Signature
Dr. H. MALLIKARJUN SWAMY.
PROFESSOR AND HEAD,
DEPARTMENT OF MEDICINE
KIMS, HUBLI.