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 CastilloPERPETUAL SUCCOUR HOSPITAL – CEBU HEART INSTITUTE
BACKGROUND OF THE STUDY
FRAMINGHAM CHD RISK
SCORE
RISK PROGNOSTICATOR
OF FUTURE CV EVENTS
MYOCARDIAL PERFORMANCE
INDEX
ECHO MEASUREOF SYSTOLIC
& DIASTOLIC FUNCTION
SIMPLE & NON INVASIVEREPRODUCIBLE
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:1. To describe the clinical and demographic profile of the
subjects 2. To determine the Framingham Coronary Heart Disease Risk
Score of the patients prior to coronary angiography 3. 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
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= 71INCLUSION CRITERIA: - CAD suspects - 2Dechocardiography- Coronary angiogram
EXCLUSION CRITERIA:- Atrial Flutter - Atrial fibrillation- Bundle branch blocks - Valvular Heart Disease
ASSESSMENT OF RISK FACTORS
- Framingham Coronary Heart Disease Risk FactorsBlood pressure Smoking statusDiabetes 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
Myocardial Performance Index= a –b b
-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
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 age and body mass index
Categorical variables: frequency and percentage
smoking , alcohol consumption, diabetes , dyslipidemia
Continuous Variables : mean ± SD
STATISTICAL ANALYSISFOR 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 SIGNIFICANTAND 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
0%
10%
20%
30%
40%
50%
60%
0 50 100 150 200 250
Fram
ingh
am R
isk
Scor
es
Gensini Score
CORRELATION OF FRAMINGHAM CHD RISK SCORE WITH GENSINI SCORING
FR
AM
ING
HA
M C
HD
RIS
K S
CO
RE
GENSINI SCORE r = 0.118, p = 0.332
0
0.2
0.4
0.6
0.8
1
1.2
1.4
0 50 100 150 200 250
Myo
card
ial
Perf
orm
ance
Ind
ex
Gensini Score
CORRELATION OF MYOCARDIAL PERFORMANCE INDEX WITH GENSINI SCORING
MY
OC
AR
DIA
L P
ER
FO
RM
AN
CE
IND
EX
GENSINI SCORE r = 0.444, p = 0.000
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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