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Left Ventricular Outflow Tract

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Introduction to Left Ventricular Outflow Tract

Left ventricular outflow tract velocity time integral (LVOT VTI) is a useful means to calculate left ventricular stroke volume and diagnose the syndrome of low cardiac output. This method is quite useful for finding out the optimal cut-off value for inotrope administration in cases of acute heart failure (Ristow and et.al., 2011). Another such parameter happens to be the Myocardial Performance Index (MPI) which is also a reliable measurement in order to evaluate left ventricular systolic and diastolic function in heart failure. Hence the requirement is to find out which best setting will produce a better LVOT VTI (Left Ventricular Outflow Track - Velocity Time Integral) and MPI (Myocardial Performance Index). There has thus been a preparation of a research proposal for the same.

The proposal starts with a description of the aims, objectives as well as research question that has been formulated for the given investigation. There is also a discussion about background studies as well as sub-sections in the literature review to get a brief overview of the topic under study. Along with this, a description of the methods to be used as well as the rationale has been ensured. This is followed by proposing the timescale of study, ethical considerations as well as health and safety concerns.

Aims And Objectives

The given research study is based on the aim to identify the best setting that will produce a better Left Ventricular Outflow Track - Velocity Time Integral and Myocardial Performance Index.

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Background And Literature Review

Sudden death because of cardiac failure is one of the major problems that are faced by most heart patients in the world. In this respect, congestive heart failure is one of the serious disorders of the heart that either leads to a disability or death. It is the inability of the heart to meet the needs of oxygen and tissues for oxygen and adequate nutrients. This leads to a decrease in cardiac output as the amount of blood that the heart pumps is also not adequate. The blood is not sufficient enough to circulate to the heart from the lungs and body which causes shortness of breath and weakness. In this respect, it is quite important to measure and interpret heart failure as well as its severity (Hosenpud and Greenberg, 2007).

Echocardiography

Echocardiography or echo test is a painless test that makes use of sound waves so as to create moving pictures of the heart. This uses standard two and three-dimensional and Doppler ultrasound so as to create images of the heart. Electrocardiography has now become the standard means so as to evaluate the severity of aortic stenosis (AS) allowing for the confirmation of diagnosis, quantization of stenosis severity and its consequences and its analysis. It is a transthoracic interpretation and evaluation of the electrical activity of the heart over a period of time (What Is Echocardiography? 2011). This is detected by electrodes that are attached to the surface of the skin and then recorded by a device that is placed outside the body. The technique is useful in the measurement of the electrical conduction system of the heart. It picks up the electrical impulses that are generated by polarization and depolarization of cardiac tissues and then translates them into a waveform.

The translated waveform is then used to measure the rate and regularity of heartbeats, the presence of any damage in the heart as well as the size and position of chambers. Echo is also enabled to detect possible blood clots inside the heart, problems with the aorta and fluid buildup in the pericardium (Baumgartner, 2009). This also measures the effects of drugs or any device like a pacemaker so as to regulate the heart. It also shows how efficiently the chambers and valves of the heart are working with respect to the flow of blood. The test of echocardiography is used in order to confirm a diagnosis or to determine the status of an existing problem in the heart as well as help in guiding a treatment (Conover, 2004).
Left ventricular outflow tract velocity time integral

A ventricular outflow tract is a portion of the left ventricle in the heart through which there is a passage of blood so that it can enter the great arteries. The left Ventricular Outflow Track (LVOT) connects to the aorta and can be differentiated from the rest of the ventricles. This outflow tract is derived from the secondary heart field during the process of cardio genesis (Mortensen and et.al. 2004). Left ventricular outflow tract velocity time integral (LVOT VTI) can be regarded as a simple method of Doppler echocardiography in order to measure the left ventricular stroke volume.

In the guidelines issued by the European Society of Cardiology, LVOT VTI

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Myocardial Performance Index

Congestive heart failure (CHF) is considered to be a major cause of mortality and disability. Patients suffering from heart failure might have gone through a phase of asymptomatic (LV) left ventricular dysfunction where objective measurements of LV reveal an impairment of cardiac contractility but this does not reveal any heart failure. There is still a lack of adequate value of different Doppler measurements and electrocardiographs in order to assess heart failure (Shingu and et. al., 2010). Recently, it has been indicated that both LV systolic and diastolic functions are the predictors for subsequent heart failure. In this respect, the Doppler-derived Myocardial Performance Index (MPI) also known as TEI-Doppler index is a fairly new index of combined systolic and diastolic function.

It refers to the sum of isovolumic contraction and relaxation time divided by the ejection time. MPI is considered to be a sensitive indicator for symptomatic heart failure in a cross-sectional type of study (Karatzis and et. al., 2009). MPI has been demonstrated to be a reproducible and reliable parameter in order to evaluate LV systolic and diastolic dysfunction in various kinds of heart disorders. In addition to this, MPI is also independent of arterial pressure, heart rate and preload. The technique is useful in the assessment of conditions where co-existence of systolic and diastolic dysfunction exist such as patients in cardiac amyloidosis, dilated cardiomyopathy, pulmonary hypertension along with right ventricular infarct and ventricular dysplasia. The technique also correlates closely with invasive measurements (Friedman and et. al., 2003). This is useful as this is an early indicator of left ventricular dysfunction in patients with normal systolic function and critical coronary artery disease.

Description Of Methods To Be Used Along With Rationale

Research strategy

The research strategy that has been used in the present study happens to be qualitative and quantitative in nature. The qualitative strategy of research will assist in interpreting the relationship that is present between Left Ventricular Outflow Track - Velocity Time Integral and Myocardial Performance Index so that the best setting can be produced. On the other hand, the usage of the quantitative research study will further aid in gaining an understanding of the processes by the usage of statistical tools and techniques.

Research design

Research design can be regarded as an essential technique for any investigation that is undertaken on a research topic (Maxwell, 2011). The present study will make use of the exploratory design of research. It further aims at gaining deep insights as well as getting familiar with the investigatory phenomenon. It also assists in providing an answer to the research question by undertaking a systematic investigation (Churchill and Lacobucci, 2009). This research design will further aid in finding the best setting by studying of literature hence it is the most suitable approach for this investigation.

Subject Selection and Description

The subjects to be selected for the present study happen to be patients who are suffering from heart failure of class third or fourth has been selected. The sample size chosen is 80 patients. This was a requirement so as to be aware of the best setting of Left Ventricular Outflow Track - Velocity Time Integral and Myocardial Performance Index in patients. Sampling involves for selection of subsets from the entire population. In this respect, there has been a usage of the purposive sampling technique. It is the one in which the sample size is selected on the basis of the knowledge of a population as well as the purpose of the study (Churchill and Lacobucci, 2009). The usage of this technique is quite apt as it would lead to the selection of only those patients that have a specific characteristic in the form of heart failure of type 3rd or 4th. The need of the researcher is to target a large number of patients within a short span of time without being much concerned about proportionality. Hence usage of purposive sampling will be at for the study.

Ethical Considerations

Ethical approval in order to conduct the research and study on patients will be taken from the appropriate NHS Research Ethics Committee which is a legal requirement. In order to achieve ethical approval from the patients under study some measures will be taken. Firstly, the participant will be given information regarding the rationale for conducting the study and what the study will result in. Prior to making a decision regarding participating in the research, participants will be given the freedom to ask any questions related to the study being conducted. They will be asked to sign a consent form which will indicate that they understand exactly what the research involves and they agree to participate in it (Suri, 2008). Along with this, participants will also be informed that they are free to withdraw from the study any time they wish to.

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Health And Safety / COSHH

All types of medical research studies have implications for health and safety. Hence, the requirement on the part of any researcher is to identify any issues related to cot health and safety. There is also a requirement to be increasingly aware of any hazards that the researcher may be exposed to while carrying out the study (Identifying risks to safety: Hazards to researchers Health & Safety, 2014). This involves for nursing safety of the entire research team. The entire team is also required to be aware of the Health and Safety implications of the proposed study.

References

  • Advantages and disadvantages of observation. 2014.
  • Ärnlöv, J. and et. al., 2004. Myocardial performance index, a Doppler-derived index of global left ventricular function, predicts congestive heart failure in elderly men.
  • Baumgartner, H., 2009. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice.
  • Chinen, D. and et. al., 2013. Left ventricular outflow tract velocity time integral correlates with low cardiac output syndrome in patients with acute decompensated heart failure. Eur Heart J. 34(1).

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