Download NEED FOR THE STUDY Hypertension is the most important health

NEED FOR THE STUDY
Hypertension is the most important health problem met by general physicians.LVH is one of
the most important complications of hypertension.
The development of left ventricular hypertrophy increases with the severity of
hypertension and presence of increased left ventricular mass is associated with increased
incidence of MI,CHF,STROKE other target organ damage.Hence LVH no longer considered
as an adaptive mechanism that compensates the pressure imposed on the heart and has been
identified as an independent and significant risk factor for sudden death ,acute MI ,CHF and
stroke.1
The incidence of LVH is on the rise ,more alarmingly in developing countries. The
Framingham heart study suggested that 1 in 10 persons will have LVH in the age 65to 69.2
Early detection and appropriate treatment decreases the development of left ventricular
hypertrophy and reduces the mortality and morbidity.ECG, 2D ECHO and chest x-ray are
different modalities for diagnosis of LVH.ECG and chest X-ray in the assessment of cardiac
dimensions has lost its prominence in favour of 2D ECHO.
Hence this study is undertaken to compare the diagnostic efficiency of these
methods in diagnosing left ventricular hypertrophy because the best means of decreasing the
increased mortality and morbidity is to prevent the development of left ventricular
hypertrophy which requires early and continuous antihypertensive therapy even before the
hypertrophy becomes clinically manifest.3
REVIEW OF LITERATURE
The cardiovascular consequences of hypertension have long been appreciated. In
1913, the famous clinician Thomas Janeway described congestive heart failure as the
manifestation of hypertensive cardiovascular disease4. Shortly after, the relationship
between hypertension and hypertrophy of the left ventricle was established in
observations linking cardiac findings to the then new technique of indirect blood pressure
measurement with sphygmomanometry.
In the Framingham heart Study,in 1990, it was shown that for each 50 g/m increase in LV
mass (corrected for height) there was a relative risk for mortality of 1.73, even in subjects
free of clinically apparent cardiovascular disease5. It was also demonstrated that this risk was
statistically independent of blood pressure, age, antihypertensive treatment, and other
cardiovascular risk factors.
Devereux and Reicheck in 1981 were the first to co-relate ECHO
LV mass estimates with
LV specimens of same hearts at biopsy6.They tested various geometric formulas and different
methods of measuring wall thickness and LVID and found that anatomic
LV mass correlated best with LV measurements by Penn convention(r=0.96) using the
following empirical equation:
.
LVmass=1.04[(IVST+LVID+PWT)3- LVID3]-13.6g
Using the American Society of Echocardiography method of measuring septal and left
ventricular wall thickness .Devereux and Woythaler et al., found a good correlation between
ECHO and anatomic LVmass.7
AIMS AND OBJECTIVES
To identify the left ventricular hypertrophy.
Comparison of relative sensitivity, and specificity of echocardiogram, standard 12
lead ECG, and chest roentgenography for detecting left ventricular hypertrophy in
essential hypertension.
Correlation of left ventricular hypertrophy and target organ involvement in
hypertensive patients.
INCLUSION CRITERIA

The study group will consisted of patients above the age of 40 year of both sexes.

All freshly detected and old cases of essential hypertension, irrespective of duration of
hypertension and type of treatment receiving will be taken into the study.
EXCLUSION CRITERIA

All cases of secondary hypertension.

Patients with previous ischemic heart disease either myocardial infarction or
ischemic cardiomyopathy.

Patients with congenital heart disease and

Patients with valvular heart disease
MATERIALS AND METHODS
SOURCE OF DATA
Study will be carried out in SRI ADICHUNCHANGIRI
INSTITUTE OF
MEDICAL SCIENCE AND RESEARCH
CENTRE,B.G.Nagar from November 2010 to April 2012.
METHOD OF COLLECTION OF DATA
The study group will consist of 50 patients of both sexes with essential hypertension
attending the outpatient clinic as well as those admitted in medical wards.
Thorough history,physical examination, chest X-ray, standard 12 lead ECG and two
dimensional echocardiography will be done for all patients
.
The following clinical information will be obtained, apart from investigations.
1. Duration of hypertension, <5 years, 6-10 years, > 11 years.
2. Number and type of antihypertensive drugs
.
3.Standard cuff blood pressure in supine and standing
.
4. Body surface area
5. Cardiovascular examination:
Site and character of apical impulse
Character of heart sounds
Presence of abnormal heart sounds and murmurs.
6. H/O stroke or recurrent transient cerebral ischemia.
STATISTICAL TESTS:
1)Diagnostic validity tests
2)Kappa measure of agreement
3)Chi-square test.
Does the study require any investigations or interventions to be conducted
on patients or other humans or animals? If so describe briefly?
YES
Investigations:
Routine investigations:
Fasting Blood Sugar
B. Urea
S. Creatinine
Fasting lipid profile
Urine
- Albmin
- Sugar
Ophthalmic examination for any evidence of hypertensive retinopathy
Specific investigations:

Chest X-ray: PA view- to measure cardiothoracic ratio

Standard 12 lead ECG

2D ECHOCARDIOGRAPHY
LIST OF REFERENCES
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versa”. Annals of internal medicine, 2000; 112:57-8.
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ventricle.”Am J Cardiol 1982:99:716-720
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Heart,edt.by Wayne Alexander, Robert C.Schalant, Valentine Fuster,8th edition,New
York,Mc Graw –Hill Companies:1992:1393
4) Janeway TC. A clinical study of hypertensive cardiovascular disease. Arch Intern
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echocardiographically determined LV mass in The Framingham Heart Study. N
Engl J Med 1990; 322: 1561-1566.
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to necropsy findings.Am J Cardiol 1986;57:450-458
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echocardiogrphic determination of left ventricular mass as reference the reference
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