A strong research program is one of the essential features of a center in the practice of achieving of excellence, and this is one of the key objectives of the Aswan Heart Center. The integrated strategic plan of the AHC consists of a continuum of population science, translational research, and basic science research targeting specific diseases prevalent in the region. An integral part of this strategy is strong national and international collaboration, with a large network of centers of excellence with whom AHC has strong relationships. AHC recognizes that the success of this plan depends largely on the center's ability to develop infrastructure, secure equipment and importantly, acquire the essential human resources.
A. Inherited Heart Muscle Disease Program
To date, this national program has served more than 600 patients that have been entered into the database with extensive clinical, imaging and genetic profiling. Of these, 300 have been genotyped - 200 of whom are index patients and 100 family members - yielding novel results which have been published in the Journal of Cardiovascular Translational Research. The program includes diligent clinical monitoring and state-of-the-art medical case management including surgical treatments using techniques developed and published by our group. The program has been significantly strengthened by purchasing and installing a robotic system in the center's genetics laboratory which has enhanced its efficiency and improved overall accuracy of results by helping to eliminate potential human error. A comprehensive program targeting family members who carry genetic mutations but with apparently “normal” hearts is underway, and holds the promise of providing a more in-depth understanding of the mechanism of disease.
B. Invasive Coronary Physiology Laboratory
This serves as a platform for investigating the effect of various diseases and treatment modalities on coronary blood flow, coronary flow reserve and microvascular function. We are currently studying the effect of extended septal myectomy on baseline and hyperemic global and regional coronary blood flow, coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients with hypertrophic obstructive cardiomyopathy. Myocardial specimens obtained during surgery will also be analyzed to determine baseline histological features including degree of myofiber disarray, capillary density, cross-sectional luminal area, arteriolar wall thickness as well as interstitial and perivascular collagen density and distribution.
C. Rheumatic Heart Disease
Several aspects of this endemic disease are being studied at the community, hospital and laboratory levels. More than 3000 school children underwent comprehensive clinical and echocardiographic screening for RHD in the first phase of the study using a set of criteria developed at AHC. In the second phase of the study, individuals with rheumatic heart disease are being followed up to various host and pathogen features that lead to progression. The Aswan Heart Centre is currently supporting the creation of similar screening programs in rural Ethiopia and Malawi. In that respect, two physicians from these areas have recently completed 6-month training programs designed to teach techniques for echocardiographic screening for RHD.
D. Bicuspid Aortic Valve Registry
This anomaly is the most common congenital anomaly of the heart and involves many components of the cardiovascular system. A dedicated principal investigator was appointed in 2011, and the data acquired is currently being jointly analyzed with the department of imaging and biophysics at Imperial College London, UK. The genetic studies will take place at our laboratory in Alexandria as the disease is known to have a strong heritable origin. This program has more than 50 patients recruited so far, and includes echocardiographic screening of first-degree family members.
E. Pulmonary Hypertension Study and Registry
This area of research addresses an extremely neglected group of diseases. AHC has recently been chosen to join a multicenter trial with several reputable centers around the world to test the efficacy of a novel drug on the progression of the disease and right ventricular function/remodeling using a number of advanced imaging tools and analysis software. A study on the prevalence and severity of bilharzial pulmonary hypertension in Sharkeyah has been completed and was published last year. Phase 2 of this study began in February 2013, where the progression of this disease and its response to pulmonary vasodilators is being evaluated.
F. Randomized Autograft versus Mechanical versus Stentless Study (RAMSES)
This is a 3-pronged, randomized study comparing the medium and long-term outcome of various options for aortic valve replacement (Ross operation vs. mechanical prostheses vs. stentless aortic roots) in terms of survival, quality of life, valve degeneration, ventricular function, arterial stiffness and coronary blood flow. The results of this study will be extremely valuable in determining the best strategy for aortic valve replacement especially in young adults. The short and intermediate-term results of stentless aortic roots in young adults are currently being studied as part of an MD thesis.
G. Mechanical Circulatory Support/Left Ventricular Assist Device Program
Mechanical circulatory support continues to provide means of survival for patients with advanced cardiac diseases until a more definitive treatment becomes available (bridge-to-transplantation) or indefinitely (destination therapy). More recently, left ventricular unloading has proven to be effective in inducing reverse remodeling and recovery of cardiac function in some patients (bridge-to-recovery). AHC aims to establish the first mechanical circulatory support/LVAD program in Egypt in 2013. Besides providing a needed service to an increasing number of patients. Such a program will serve to develop a better understanding of myocardial regeneration and various biological pathways by which the heart muscle recovers from various insults.