RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / Name of the candidate
and
Address
(in block letters) / DR.MOHAMMED ANSARI GAFFOOR
#11, 1ST FLOOR, KEMP ROAD,
OPP. COLES PARK,
BANGALORE-560 005.
2. / Name of the institution / M.V.J. MEDICAL COLLEGE AND RESEARCH HOSPITAL
3. / Course of study and subject / M.D. (RADIODIAGNOSIS)
4. / Date of admission to course / 30-05-2009
5. / Title of the Topic
EVALUATION OF CAROTID INTIMA-MEDIA THICKNESS BY HIGH RESOLUTION ULTRASOUND IN HYPERTENSIVE PATIENTS COMPARED WITH NORMOTENSIVES
6. / Brief resume of the intended work:
6.1 Need for the study
Vascular system of human body is prone for atherosclerosis by various risk factors among which hypertension is an important and independent risk factor. It is one of the major killers throughout the world and Asians are more prone for atherosclerosis compared to western world. So, it is very essential to implement a comprehensive method for identification of initial atherosclerotic events in high-risk patients and also in general public so that more vigorous preventive measures can be taken. Various non-invasive markers of early arterial wall alteration are currently available. Of them, Intima - media thickness (IMT) of large arterial walls, especially carotid is an important parameter that can be assessed by high resolution sonography in a relatively simple way and represents a safe, inexpensive, precise and reproducible measure. Intima- media thickness [IMT] as morphological value reflects the atherosclerotic process in an indirect manner and this can be assessed as a surrogate marker of generalized atherosclerosis. In our study this parameter will be assessed in common carotid arteries of hypertensives and normotensives, and the results will be compared.
6.2 Review of literature
Adaikkappan M et al1 in 2002 studied two hundred and sixty patients of hypertension over a period of three years and compared with seventy normotensive patients and concluded that, intima media thickness of common carotid artery is significantly increased in hypertensives when compared to normotensives.
Beat Frauchiger, MD et al2 in 2001 concluded that the resistive index of the carotid artery can be assessed as a surrogate marker of generalized atherosclerosis complementary to intima media thickness [IMT], and compared with other indirect measurements of atherosclerosis e.g., distensibility, the ease with which resistive index data are obtained is striking.
F.L. Plavnik et al3 in 2000 conducted a study of common carotid and femoral arteries by non-invasive B-mode ultrasound in 63 normotensive and in 52 hypertensive subjects and the intima media thickness was tested for correlation with blood pressure and concluded that the use of a noninvasive method such as B-mode ultrasound for the carotid and femoral arteries is reliable and helpful in evaluating hypertensive patients. Amongst the several factors which have an impact on target organs, age and high blood pressure levels appear to be the main predictors of increased thickening of the arterial wall.
Simons PC et al4 evaluated the diagnostic ability of intima media thickness and distensibility to discriminate between low- and high-risk patients and they concluded that the common carotid intima media thickness and distensibility are clear markers of cardiovascular risk in patients who already have vascular disease or atherosclerotic risk factors. Intima media thickness appears to discriminate between low- and high-risk patients better than distensibility.
Carola Lemne et al5 evaluated the relationships of intima-media thickness and plaque occurrence to atherosclerotic risk factors such as age, smoking, lipoprotein levels, and fasting insulin levels and concluded that there is a consistent increase in intima media thickness and plaque occurrence in men with hypertension compared with normotensive control subjects.
Lemne C et al6 showed that Intima media thickness [IMT] is increased in hypertensives compared with age and sex matched normotensives and there is powerful evidence to link blood pressure to clinical cardiovascular pathology. They also showed that hypertension predisposes both sexes to ischemic infarction of the myocardium both in elderly and young age groups, and isolated systolic hypertension is associated with a greater than two fold risk of cardiovascular disease.
6.3 Objectives of the study
1.  To assess the carotid intima media thickness (IMT) in hypertensive patients using high resolution ultrasonography.
2.  To compare the intima media thickness of hypertensive patients with that of normotensives.
7. / Materials and Methods:
7.1 Source of data
Fifty patients referred to Department of Radio diagnosis at M.V.J.Medical College and Research Hospital, with clinically diagnosed hypertension and fifty normotensive subjects.
7.2 Method of collection of data (including sampling procedure, if any)
Definition of a study subject:
Fifty patients in age group of 35-55years found to be suffering from primary hypertension without any symptoms visiting MVJMC&RH.
The method of study consists of:
A structured, pre-prepared case proforma will be used to enter the clinical history, physical examination findings and investigations-hematological, urinary and high resolution sonography findings. Those who will meet the inclusion and exclusion criteria will be included in the study and using GE VOLUSON 730 PRO scanner with 7.5-10 MHZ linear array transducer, both the common carotid arteries intima media thickness will be assessed and tabulated.
Inclusion criteria:
All male and female patients suffering from primary hypertension without any symptoms and within the age group between 35-55years.
Exclusion criteria:
History of secondary hypertension, diabetes mellitus, smoking, obesity and postmenopausal women.
Definition of a control subject:
Fifty individuals in age group of 35-55years whose age and sex matched with study group with no history of primary hypertension.
Inclusion criteria:
All male and female subjects without hypertension and within the age group between 35-55years.
Exclusion criteria:
Normotensive subjects with history of diabetes mellitus, smoking, obesity and postmenopausal women.
Statistical Methods:
Chi-square test will be used to find the significance of proportions of hypertensives in different age groups. Student ‘t’ test will be used to find the significance of Blood Pressure parameters and Intima media thickness [IMT] between normotensives and hypertensives. The Statistical software namely SPSS will be used for the analysis of the data and Microsoft word and Excel will be used to generate graphs, tables etc.
7.3 Does the study require any investigation or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.
Yes, the present study requires:
High resolution sonography of common carotid arteries.
Urine – Protein, RBC, Glucose.
Blood – RBS, Serum creatinine, Lipid profile.
ECG.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes
8. / List of references
1.  Adaikkappan M, Sampath R, Felix AJW, Sethupathy S. Evaluation of carotid atherosclerosis by B’mode ultrasonographic study in hypertensive patients compared with normotensive patients. Indian J Radio Imaging 2002; 12(3):365-368.
2.  Beat Frauchiger, MD; Hans Peter Schmid, MD; Christian Roedel, MD; Peter Moosmann, MD, PhD; Daniel Staub, MD. Comparison of carotid arterial resistive indices with Intima-Media thickness as sonographic markers of Atherosclerosis. Stroke 2001; 32:836-838.
3.  F.L. Plavnik, S. Ajzen, O. Kohlmann Jr., A. Tavares, M.T. Zanella, A.B. Ribeiro and O.L. Ramos. Intima-media thickness evaluation by B-mode ultrasound. Correlation with blood pressure levels and cardiac structures. Brazilian Journal of Medical and Biological Research 2000; 33:55-64.
4.  Simons PC, Algra A, Bots ML, Grobbee DE, van der Graaf Y. Common carotid intima-media thickness and arterial stiffness: indicators of cardiovascular risk in high-risk patients. The SMART Study (Second Manifestations of ARTerial disease). Circulation 1999; 100(9):951–957.
5.  Carola Lemne, MD; Tomas Jogestrand, MD, PhD; Ulf de Faire, MD, PhD. Carotid intima-media thickness and plaque in borderline hypertension. Stroke 1995; 26:34-39.
6.  Lemne C, Jogestrand T, de Faire U. Non invasive assessment of vessel – wall changes in Hypertensive and normotensive controls. Clin Physiol 1992; 12:497-502.
9. / Signature of Candidate
10 / Remarks of the Guide
Evolution of the high end ultrasound in modern practice has made it possible to study the vascular wall in relation to hypertensive patients and hence this study is useful because of its repeatability, safety and non invasive nature.
11 / Name & Designation of
(in block letters)
11.1 Guide
DR.GEETA S SHANKAR
MD (RADIO-DIAGNOSIS)
PROFESSOR
11.2 Signature
11.3 Co-Guide
DR.P.CHANDRASEKHARA
PROFESSOR & HOD
DEPARTMENT OF MEDICINE
11.4 Signature
11.5 Head of Department
DR. T. RAMACHANDRA PRASAD
PROFESSOR & HOD OF RADIO-DIAGNOSIS
11.6 Signature
12 / 12.1 Remarks of the Chairman And Principal
12.2 Signature