1. 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

2. 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

3. 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?

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

5. 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

6. 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

7. 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

8. 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

9. 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 %
c. and high risk for >20%.3 *

10. 2ECHOCARDIOGRAPHY with PULSED WAVE DOPPLER
2ECHOCARDIOGRAPHY with PULSED WAVE DOPPLER
GE Vivid 7
complete standard echocardiography study

11. 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

12. 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

13. 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

14. 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

15. RESULTS

16. CLINICAL & DEMOGRAPHIC PROFILE

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

18. RISK FACTORS DISTRIBUTION BASED ON SIGNIFICANT & INSIGNIFICANT CAD

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

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

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

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

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

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

25. 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)

26. THANK YOU