Ballana Heart Study
The Ballana Heart Study aims at defining the cardiovascular phenotype, biomarkers, genotype, and risk factors with follow up for up to 30 years in a defined population in Egypt.
AHC Research areas consists of a continuum of population science, translational, and basic science research targeting specific diseases with significant relevance to the population of Egypt, Africa and the world. The matrix is presented with the vertical columns representing the population studies and disease-based projects and the horizontal columns representing the available state-of-the-art science and engineering platforms available at AHC.
A fundamental component of AHC’s mission is to develop and promote a well-designed landscape of ‘Platforms of integrated Healthcare and Research’. These platforms are strengthening AHC in being a Centre of Excellence in Patient Care and Cardiovascular Research. Our Molecular and Biomedical Engineering Platforms include cutting-edge laboratories that allow investigating disease from cellular and molecular research to advanced patient-specific imaging as well as computational modeling.
Population science is particularly important as it sets the frame for all the other programmes at AHC. It helps us understand ethnic and racial disparities in the population burden of CVD, which is crucial to effective prevention and treatment. Important examples worldwide include the Framingham study, the Dallas Heart Study in the US, the Copenhagen City Heart Study in Denmark, and the Lollipop study in West London. To date there has been no similar studies in Egypt or the Middle East. based Programme, highlighting background/relevance, objectives, progress to date and future directions. Data regarding cardiovascular disease prevalence in African countries including Egypt is scarce. Population and epidemiological Studies at AHC will help producing high quality data that are crucial to improving health policy and reducing preventable deaths.
Cardiomyopathy is known to be genetically heterogeneous, therefore not only in patients, but also their families can suffer from this disease. At AHC, we focus on the most prevalent forms of cardiomyopathy in the general population and its inheritance. We are a referral centre for Hypertrophic Cardiomyopathy (HCM) patients in Egypt, including those suffering from left ventricular outflow tract obstruction (LVOTO) and surgical relief of the obstruction (myectomy). Around 30 operations are performed per year at AHC. The focus of research at AHC includes profound characterization of the structure and genetics in patients and their relatives, and identify new criteria for enhanced diagnosis and follow-up.
The incidence of heart failure in the MENA Region is rising and is thought to be one of the highest in the world 3,5. It was, therefore, essential to establish a heart failure program with a strong clinical and research element. The Left Ventricular Assist Device (LVAD) Recovery Program at AHC was established as a bridge-to-recovery program and aims to improve myocardial function with specific medication protocol and cell therapy and to study biomarkers relevant to prediction and patient monitoring.
One of our largest contribution to treating CAD in Egypt, is the AHC 24/7 primary percutaneous coronary intervention (PCI) Programme, where patients suffering from acute blockage of the coronary arteries (heart attack) are rushed into the cardiac catheterization laboratory to have their arteries opened mechanically. It is currently the only programme offering this service in the Governorate of Aswan, performing 400 -450 primary PCI procedures per year. The program serves a population of one million inhabitants and offers rescue and pharmacoinvasive PCI to another one million individuals.
The aortic root structure and dynamism are responsible for maintaining optimal coronary flow, left ventricular function, and cardiac output under a wide range of hemodynamic conditions,. This is relevant to several operations and interventions being performed at AHC, such as Yacoub Valve- sparing Remodeling Operation, Valve Repair, the ROSS operation, the TAVI Programme, and others. Advanced imaging (such as CMR 4D Flow) and computational methods for Flow and Structural Deformation modeling are being utilized for patient-specific investigations, to ensure and optimize geometry, dynamism and function of each component part of the root and valves. Histopathology and cellular assessments are performed postoperatively for disease-oriented analysis.
Bicuspid aortic valve (BAV) syndrome is the most common congenital cardiac defect affecting 1- 2 percent of the population and is one of the important focus areas at AHC. The condition is very heterogeneous, affects multi organ systems, particularly the aortic valve mechanism, the ascending aorta and arch and possibly the myocardium. Clinically BAV can present as slowly progressive heart failure, silent aortic dilatation or acutely as rupture or dissection of the aorta. In addition, other factors are believed to play an important role in determining the phenotype and progression of the BAV syndrome. These include biomechanical, biochemical, metabolic and immunological, all of which are known to play important roles in other common disease processes such as atherosclerosis or thoracic aortic aneurysms.
RHD is a major cause of morbidity and mortality with 3 million people affected worldwide and 300,000 young people dying every year mainly in low and middle-income countries 6. Current available evidence indicates that the disease is particularly prevalent in Egypt 7. This is supported by the fact that 20% of open-heart surgeries performed at the Aswan Heart Centre are offered to patients suffering from to rheumatic heart disease. We conduct research to investigate immunological and pathogenic of RHD and its impact on human valves from cellular to mechanical aspects, to achieve enhanced prediction and surgery
The prevalence of consanguinity (diseased due to intermarriages) in Egypt is known to be large 8 . The influence of this factor on the prevalence of specific types of CHD is not yet known. At AHC, we conduct genetic studies of this nature with emphasis on the Egyptian population. The Biomedical research teams support surgeons by modelling patient-specific anatomy of complex cases, using imaging, advanced post-processing tools and 3D printing, to optimize preoperative planning, and thus, surgical outcome.
Pulmonary Hypertension is a group of diseases which is both neglected and underestimated both globally and particularly in Egypt. Although the main pathological changes are in the small vessels of the lungs, both the morbidity and the mortality result from failure of the right ventricle. The disease has been classified originally in 1942 by Paul Wood into vasospastic, obliterative, hyperkinetic, and passive. Since then the disease has been classified by a series of meetings of the WHO.