Sample Reports
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Sample Reports

The numeric score and identified conditions are compiled into an easy-to-read report which the physician can review on the MCG unit, or any computer with a web browser and PDF viewer.



Test_data.pdf
Test_data.pdf
Severity Scores and Clinical Guidelines

MCG testing generates a report that includes a multiphase probability score of ischemic heart disease severity and additional index patterns suggesting the presence diagnoses or conditions. These findings require rigorous clinical validation and should be considered as expert opinion only and not a definitive diagnosis.

Disease Severity Scores range from 0 to 22, with 0 representing no ischemic disease burden and 15 or greater as extremely severe ischemia. MCG scores are associated with specific clinical guidelines for triage and treatment. Primary care physicians or non-cardiac specialists can use MCG to help them determine when a referral to a cardiovascular specialist is warranted. Patients tested with multiphase severity scores of less than 4.0 can be safely managed without specialty consultation.





Patients with clinically moderate scores (4 ≤ x < 7.5) should be referred for a cardiology consultation and nuclear myocardial perfusion imaging; however, half will have normal perfusion test results and will be continued on optimal medical therapy. This group of patients is at high risk for myocardial infarction. Two-thirds of heart attack or sudden cardiac death victims have less than 50% cardiac narrowing prior to the event and MCG is the only available non-invasive test to reliably detect obstructions of <70% severity.  Identifying high-risk patients with MCG allows

physicians to closely evaluate their prescribed treatment regimens (and patient compliance). This greater visibility enables physicians to utilize optimal medical management and lifestyle modification, with adjunctive interventional or surgical intervention if needed, while the disease is reversible. All patients with scores of 2 or higher should be retested periodically since the severity score is a dynamic number able to change as conditions of myocardial perfusion change. All post-intervention patients should be carefully monitored for increases in scores related to either re-stenosis or progression of underlying disease.

SUGGESTED COURSES OF ACTION:

0 – No intervention is required. Maximize preventive measures including management of all identifiable risk factors, implementing diet and life style improvements as well as cardiac wellness management to optimize serum lipid-profile (total cholesterol of <130 mg/dl and LDL of <100 mg/dl). Follow up with annual MCG tests.

0 < x <2 – Neither stress testing (which will more than likely be normal) nor intervention is required.  Maximize preventive measures including management of all identifiable risk factors, implementing diet and life style improvements as well as cardiac wellness management to optimize serum lipid-profile (total cholesterol of <130 mg/dl and LDL of <100 mg/dl). Follow up with annual MCG tests.

2 ≤ x <4 - Neither stress testing (which will more than likely be normal) nor coronary intervention is required.  Maximize preventive measures including management of all identifiable risk factors, implementing diet and life style improvements as well as cardiac wellness management to optimize serum lipid-profile (total cholesterol of <130 mg/dl and LDL of <100 mg/dl). Annual MCG follow-up testing as well as outpatient monitoring for ischemia and ventricular arrhythmia are recommended.

4 ≤ x < 7.5 – Maximize preventive measures including management of all identifiable risk factors, implementing diet and life style improvements as well as cardiac wellness management to optimize serum lipid-profile (total cholesterol of <130 mg/dl and LDL of <100 mg/dl). Cardiology consultation, echocardiography, and nuclear myocardial perfusion imaging should be undertaken. If perfusion imaging is positive for ischemia, aggressive vascular intervention in the form of cardiac catheterization (in particular for those with test results showing local/regional ischemia) and optimal medical management are essential. If adjunctive testing is negative for ischemia, the patient should be treated with optimal medical management and observed closely for further changes in MCG scores. Post-intervention care should include periodic MCG follow-up testing as well as outpatient monitoring for ischemia, ventricular arrhythmia, and/or progressive CHF events. If ventricular arrhythmias or CHF with EF% < 35% are present based on MCG results and adjunctive evaluation, a referral for EP Consultation is appropriate.

7.5 ≤ x ≤ 15- Patient should be referred for urgent cardiology consultation, undergo further testing including echocardiography and nuclear myocardial perfusion imaging, and receive active consideration for coronary angiography and possible percutaneous coronary interventional procedures. (This also applies to a patient in the ER at the time of the test). Post-intervention care should maximize preventive measures including management of all identifiable risk factors, implement diet and life style improvements as well as cardiac wellness management to optimize serum lipid-profile (total cholesterol of <130 mg/dl and LDL of <100 mg/dl). MCG follow-up testing as well as outpatient monitoring for ischemia, ventricular arrhythmia, and/or progressive CHF events are recommended. If ventricular arrhythmias or CHF with EF% < 35% are present based on MCG results and adjunctive evaluation, a referral for EP Consultation is appropriate.

x >15 – Consider inpatient admission for urgent cardiology evaluation, hemodynamic assessment, coronary angiography, and possible percutaneous coronary interventional procedures. Post-intervention care should maximize preventive measures including management of all identifiable risk factors, implement diet and life style improvements as well as cardiac wellness management to optimize serum lipid-profile (total cholesterol of <130 mg/dl and LDL of <100 mg/dl). MCG follow-up testing as well as outpatient monitoring for ischemia, ventricular arrhythmia, and/or progressive CHF events are recommended. If ventricular arrhythmias or CHF with EF% < 35% are present based on MCG results and adjunctive evaluation, a referral for EP Consultation is appropriate.

Some Practical Recommendations

For patients with angina: When a patient is symptomatic with angina pectoris, regardless of the MCG scores, test them immediately with Echocardiography and Myocardial Perfusion Imaging.  Patients with Angina Pectoris at rest or progressive forms of Angina should be referred to an Emergency Room for evaluation. Follow-up according to post cardiology workup or intervention as indicated below for 3, 6, 9, and 12 moths follow-up tests.

For asymptomatic patients with one or two major risk factors, male > 40 and female > 50 initial test to establish a baseline,


For patients undergoing PCI or CABG:


Pre-OP Medical Clearance for Patients Undergoing Non-Cardiac Surgery:


   o Scores > 4, cardiology consultation
    o Scores < 4, cleared


o Initial test
o Cardiology Consultation.

Disclaimer:

These preliminary recommendations/expert opinions are based on experiences accumulated over years of clinical research, from data on coronary patho-physiology, and published clinical treatment guidelines.  Further clinical validation in the form of out-come trials will be required to refine, reject, or adopt these recommendations.

Sample reports for normal and abnormal patients

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