Jennifer Doria-del Castillo   MYOCARDIAL PERFORMANCE INDEX COMBINED WITH FRAMINGHAM CORONARY HEART DISEASE RISK SCORE IN DETERMINING ANGIOGRAPHIC SEVERITY OF CORONARY ARTERY DISEASE BY GENSINI SCORING Jennifer Doria-del Castillo PERPETUAL SUCCOUR HOSPITAL – CEBU HEART INSTITUTE

BACKGROUND OF THE STUDY FRAMINGHAM CHD RISK SCORE RISK PROGNOSTICATOR OF FUTURE CV EVENTS MYOCARDIAL PERFORMANCE INDEX ECHO MEASURE OF SYSTOLIC & DIASTOLIC FUNCTION SIMPLE & NON INVASIVE REPRODUCIBLE INDEPENDENT OF LV GEOMETRY GENSINI SCORE VALIDATED MEASURE OF ANGIOGRAPHIC SEVERITYOF CAD

  RESEARCH QUESTION: Can Myocardial Performance Index combined with Framingham Coronary Heart Disease Risk Score determine angiographic severity of coronary artery disease assessed by Gensini scoring?

GENERAL OBJECTIVE : To investigate whether Myocardial Performance Index when combined with Framingham Risk Score determine angiographic severity of Coronary Artery Disease

SPECIFIC OBJECTIVES: To describe the clinical and demographic profile of the subjects To determine the Framingham Coronary Heart Disease Risk Score of the patients prior to coronary angiography To determine the Myocardial Performance Index by 2DEchocardiography of the patients prior to coronary angiography

  SPECIFIC OBJECTIVES: 4. To determine the proportion of patients with significant obstructive coronary artery disease among patients who underwent coronary angiogram 5. To determine the angiographic severity of coronary artery disease by Gensini scoring 6. To compare the Framingham Coronary Heart Disease Risk Score and Myocardial Performance Index between patients with significant coronary artery disease and with insignificant coronary artery disease 7. To determine correlation between Myocardial Performance Index and angiographic severity of coronary artery disease by Gensini Score 8. To determine correlation between Myocardial performance Index combined with Framingham Coronary Heart Disease Risk Score in the assessment of angiographic severity by Gensini scoring

Study Design: prospective , analytical cross sectional study   METHODOLOGY Study Design: prospective , analytical cross sectional study Study Setting: Perpetual Succour Hospital- Cebu Heart Institute , a private , tertiary hospital with a 250 bed capacity located in Cebu City with cardiac specialty units Study Period: June 2011 – February 2012

STUDY POPULATION: N= 71 INCLUSION CRITERIA: EXCLUSION CRITERIA:   STUDY POPULATION: N= 71 INCLUSION CRITERIA: CAD suspects 2Dechocardiography Coronary angiogram EXCLUSION CRITERIA: Atrial Flutter Atrial fibrillation Bundle branch blocks Valvular Heart Disease

ASSESSMENT OF RISK FACTORS   ASSESSMENT OF RISK FACTORS - Framingham Coronary Heart Disease Risk Factors Blood pressure Smoking status Diabetes mellitus Lipid levels ( total cholesterol and HDL levels) - On line analysis* Classified based on the National Cholesterol Education Program/Adult Treatment Panel III for 10 yr risk of Coronary Heart Disease into 3 categories a. low risk for score <10% b. intermediate risk for 11-20% c. and high risk for >20%.3 *http://www.mdcalc.com/framingham-coronary-heart-disease-risk-score-si-units http://www.mdcalc.com/framingham-coronary-heart-disease-risk-score-si-units/

2ECHOCARDIOGRAPHY with PULSED WAVE DOPPLER   2ECHOCARDIOGRAPHY with PULSED WAVE DOPPLER GE Vivid 7 complete standard echocardiography study

GE Vivid 7 Complete Standard Echo Study   GE Vivid 7 Complete Standard Echo Study MPI = sum of interventricular contraction time and relaxation time divided by ejection time MPI = ICT + IRT Ejection Time Myocardial Performance Index= a –b b

GENSINI SCORE Sullivan R et al: A New Method pf Scoring Coronary Angiograms to Reflect Extent of Coronary Atherosclerosis and improve Correlation with Major Risk Factors . American Heart Journal 1990; 119;1262

STATISTICAL ANALYSIS Descriptive statistics : mean ± SD   STATISTICAL ANALYSIS Descriptive statistics : mean ± SD age and body mass index Categorical variables: frequency and percentage smoking , alcohol consumption, diabetes , dyslipidemia Continuous Variables : mean ± SD

  STATISTICAL ANALYSIS FOR THE TEST OF INFERENCES : Chi square test of independence and Fischer Exact Test: categorical variables Pearson r product Moment Correlation: continuous variables Multiple Regression : partial and combined correlations among Framingham Coronary Heart Disease Risk score and Myocardial performance index in predicting Gensini scores. p-value lesser than 0.05 alpha level considered significant

RESULTS

CLINICAL & DEMOGRAPHIC PROFILE

DISTRIBUTION OF PATIENTS BASED ON SIGNIFICANT AND INSIGNIFICANT CAD BY VESSEL SCORE

  RISK FACTORS DISTRIBUTION BASED ON SIGNIFICANT & INSIGNIFICANT CAD

  DISTRIBUTION OF PATIENTS BASED ON FRAMINGHAM CHD RISK SCORE & THE PRESENCE OF SIGNIFICANT OR INSIGNIFICANT CAD BY ANGIOGRAPHY FRAMINGHAM CHD RISK SCORE

  DISTRIBUTION OF PATIENTS BASED ON MYOCARDIAL PERFORMANCE INDEX & THE PRESENCE OF SIGNIFICANT OR INSIGNIFICANT CAD BY ANGIOGRAPHY

  DISTRIBUTION OF PATIENTS BASED ON FRAMINGHAM CHD RISK SCORES & MPI PEGGED TO THE GENSINI SCORE 0.33

CORRELATION OF FRAMINGHAM CHD RISK SCORE WITH GENSINI SCORING r = 0.118, p = 0.332 GENSINI SCORE

CORRELATION OF MYOCARDIAL PERFORMANCE INDEX WITH GENSINI SCORING r = 0.444, p = 0.000 GENSINI SCORE

FITTED MODEL PLOT OF THE COMBINED FRAMINGHAM CHD RISK SCORE AND MPI WITH THE GENSINI SCORE

CONCLUSIONS: FRAMINGHAM RISK SCORE NO significant correlation with GENSINI SCORE (r = 0.118, p = 0.332) MYOCARDIAL PERFORMANCE INDEX Moderate Correlation with GENSINI SCORE (r = 0.444, p = 0.00) FRAMINGHAM RISK SCORE + MYOCARDIAL PERFORMANCE INDEX SLIGHT TO MODERATE POSITIVE ADD ON CORRELATION (20%) TO GENSINI SCORE (R = 0.199)

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