Download - Final Dissertation

Maharashtra University of Health Sciences, NashikThesis for MD (Anatomy)

Name of the Candidate: Dr. HEMLATA DHANRAJ CHIMNE

Name of the college:NKP Salve Institute of Medical Sciences and Research Centre, Nagpur.

Name of the Guide:

DR. D.D. KSHEERSAGAR,Professor and Head, Department of Anatomy, NKP SIMS and RC, Nagpur.

Name of the Course: MD

Name of the Subject: ANATOMY

Admission Year/ Academic Year

20072007-2010

Topic: STUDY OF PALMAR DERMATOGLYPHICS IN CORONARY ARTERY DISEASE


Name of the Course: MD

Name of the Subject: ANATOMY

Admission Year/ Academic Year

2007 2007-2010

Topic: STUDY OF PALMAR DERMATOGLYPHICS IN CORONARY ARTERY DISEASE


STUDY OF PALMAR DERMATOGLYPHICS

IN

CORONARY ARTERY DISEASE

Thesis submitted to

MAHARASHTRA UNIVERSITY OF HEALTH SCIENCES,

NASHIK

For the degree of

MD

in

ANATOMY

MAY-2010


CONTENTS_____________________________________________________________

Sr. Chapter Page No_____________________________________________________________

1. Introduction 001

2. Aims and Objectives 004

3. Review of Literature 005

4. Material and Methods 041

5. Results 061

6. Discussion 101

7. Summary and Conclusions 112

8. Bibliography -----

9. Annexure -----

- Abbreviations

- Master sheet

____________________________________________________________________

01


INTRODUCTION:

Dermatoglyphics is the scientific study of epidermal ridges and their

configurations on the palmar region of hand and fingers and plantar region of

foot and toes. The term dermatoglyphics was coined by Cummins and Midlo

in 1926 and was derived from Greek words ‘derma’ means skin and ‘glyphics’

means carvings (Penrose LS, 1963)87.

The ridge pattern depends upon the cornified layer of epidermis and

dermal papillae. The typical patterns of epidermal ridges are determined since

their formation in foetus. There is proliferation of cells in the lower zone of

epidermis which projects into the dermis as a regularly spaced thickenings

and the dermis subsequently projects upward in the epidermal hollows. This is

followed by the appearance of elevations formed by them on the skin surface

which gives rise to epidermal ridges. (Cummins and Midlo, 1926)24.

The ridges are differentiated in their definitive forms during third and

fourth month of foetal life and once formed remain permanent and never

change throughout the life except in the dimension in proportion to the growth

of an individual. The original ridge characteristics are not disturbed unless the

skin is damaged to a depth of about one millimeter (Cummins and Midlo,

1943)25.

Development of dermatoglyphic pattern is under genetic control. This is

evident from the clear resemblance of dermatoglyphics among related person

(Schaumann and Alter, 1976)109. There are many diseases known to be


caused by abnormal genes. Whenever there is any abnormality in the genetic

make up of parents it is inherited to the children and is reflected in

dermatoglyphic pattern. (Walkar, 1964)124.

Dermatoglyphics as a diagnostic aid is now well established in a

number of diseases, which have a strong hereditary basis, and is employed

as a method of screening abnormal anomalies (Holt SB, 1961)55.

Apart from its use in predicting the diagnosis of genetic disease,

dermatoglyphics is also used in forensic science for individual identification. It

is also a valuable research tool in the field of Physical Anthropology, Human

Genetics and Medicine. The research findings put forth by some scientists

suggest that muzzle prints of animals similar to fingerprints in human being

could be used as permanent method of identification of such animal to check

fraud particularly in insurance matter (Tarasiuk SI et al., 1997)117.

The etiology of Coronary Artery Disease (CAD) is multifactorial with

genetics playing an important role. Taking into consideration of genetic

predisposition of dermatoglyphics and coronary artery disease, the study was

undertaken to find out correlation between them. So that dermatoglyphics

may be helpful in the diagnosis of predisposition towards this disease at an

earlier age.

The knowledge of dermatoglyphic pattern in patients with CAD is an

interesting matter and little information is available about this relation. Thus,

with regard to the high incidence of CAD in the world, the existence of such

relation might be important in the screening program for prevention of CAD. If

02


an individual with specific pattern of dermatoglyphic is present in CAD, then

the person can be screened for prevention by controlling other risk factors in

early detection program.


AIMS AND OBJECTIVES:

Coronary Artery Disease is the most important cause of mortality and

morbidity in the world. The knowledge of major risk factors can be useful in

the prevention of CAD. Few studies has been carried out on dermatoglyphics

in myocardial infarction or acquired heart disease, but in spite of extensive

scanning of literature no reference was found on dermatoglyphic patterns in

angiographically proven CAD. Against this background present study is

carried out with following aims and objective:

1. To study the finger and palmar dermatoglyphics pattern in Coronary

Artery Disease and its different Groups.

2. To establish sexual and digital differences in dermatoglyphic patterns

of CAD.

3. To compare dermatoglyphic configurations of CAD with the Controls.

4. To find out whether a specific dermatoglyphic trait/ features exists in

CAD patients and whether it is significant.


REVIEW OF LITERATURE:

The overview of literature is described in three parts:

I. REVIEW OF DERMATOGLYPHICS

II. CORONARY ARTERY DISEASE

III. DERMATOGLYPHICS AND CORONARY ARTERY DISEASE

I. REVIEW OF DERMATOGLYPHICS

The literature available on the subject is reviewed under the following heads:

1. DERMATOGLYPHICS AND ITS HISTORICAL BACKGROUND:

Since an ancient era, one or the other way the Dermatoglyphics

remains the subject of interest to various Palmist, Philosophers and Scientist.

Dermatoglyphics is a scientific study of epidermal ridges and their

configuration on volar aspects of hands, fingers, feet and toes.

The patterned traceries of fine ridges on finger, palm and soles must

have aroused interest long time ago. There are records that show

acquaintance with these traceries or dermatoglyphics long ago, prior to its

scientific study. The most telling fragment of this unwritten history is an

aboriginal Indian carving found on rock at the edge of Kejimkoojik Lake in

Nova Scotia. There are lines representing dermatoglyphics and flexion

creases within the outline of a human hand. These petroglyphs depict human

hand which roughly represent the dermatoglyphics and flexion creases. Such

ancient stone carvings are found all over the world. The most famous of


ancient “ Finger Print” designs are carvings on the walls of a Neothilic burial

passage situated on an island of Brittany L’iie de Gavr’inis, Its inner walls are

covered with incised designs of circular patterns, spirals, arches, sinuous and

straight lines occurring on various combinations. Stockis and Bridges claimed

that these carvings represent dermatoglyphics. (Cummins and Midlo, 1961)26

More purposeful recording of an identifying finger prints in clay is seen

in a case of Chinese seal dating back to a period of third century B.C. and its

importance as personal identification was known even during that period.

Dermatoglyphics patterns were also used for fortune telling in

accordance with the number of loops and whorls on fingers.

Mehemiah G (1684)73 presented a report before Royal Society of

London describing epidermal ridge, and their arrangement of finger patterns

and palm of one hand.

Bidloo G (1685)14 described an account on arrangement of epidermal

ridges on thumb in his book on Human Anatomy.

Malphigi Marcello (1686)69, professor of Anatomy at Bologra

University, noted ridges, spirals and loops in fingerprints. A layer of skin was

named after him, “Malphigi” layer.

Purkinje JE (1823)96 published his thesis describing nine fingerprint

patterns. 1. Plain arch (Transverse curve), 2. Tented arch (Central long strip),

3. Loop Ulnar or Radial (Oblique strip), 4. Oblique loop (Ulnar or Radial), 5.

Whorl (Almond), 6. Spiral whorl, 7. Elliptical whorl.


Sir Herschel WJ (1858)52 Chief Magistrate of Hooghly district in

Bengal, India was the first to use finger print identification against

impersonation. He started the practice of recording fingerprints to prevent the

impersonation of signatures. He first used fingerprints on native contract. He

made a habit of requiring palm prints and later index and middle fingers on

every contract made with the locals.

Faulds H (1880)34 used fingerprints for identification of criminals. He

published an article in the scientific journal ‘Nature’ discussing fingerprints as

a means of personal identification and use of printers ink as a method of

obtaining such fingerprints. He made first fingerprint identification of a

greasery fingerprint left on the alcohol bottle.

Mark Twain’s (1883)72 book ‘Life on the Mississippi’, a murderer was

identified by the use of fingerprint identification.

Sir Galton Francis (1889)38, a British anthropologist began his

observation of fingerprints as a means of identification. His attention had first

been drawn to the ridges in 1888 when he was studying the problem of

person identification. His primary interest in fingerprints was an aid in

determining heredity and racial background. Fingerprints do not change

during the course of an individual’s lifetime and that no two fingerprints are

exactly the same.

Sir Galton Francis (1892)39 published a book “Fingerprints” which

included the first classification for fingerprints. Galton also identified the

characteristics by which the fingerprints can be identified. These same


characteristics (minutia) are basically still in use today and referred to as

Galton’s details.

Vucetich J (1892)123, an Argentine police official made the first criminal

fingerprint identification. He identified a woman named Rojas, who murdered

her two sons but her bloody print was left on a door post, proving her as

murders.

Thompson G (1892)119 of US Geological survey in New Mexico, used

his own fingerprints on a document to prevent forgery. This is the first known

use of fingerprints in the US.

Tarbour (1892)118, a photographer in San Francisco practiced the

inkprint method for the registration of Chinese immigrants.

Wilder HH (1897)128 initiated a biological investigation with study of

comparative dermatoglyphic. He devoted his studies to morphology and

methodology of palmer and plantar dermatoglyphics inheritance and racial

differences.

The introduction of fingerprints for criminal identification was started in

1901 in England and Wales using Galton’s observation revised by Sir Edward

Richard Henry.

The first systematic use of fingerprints in US, New York Civil Service

Commission for testing was introduced in 1902. Police departments and law

enforcement agencies in US use fingerprints for personal and criminal

identification from 1903 onwards.


Bonnevie K (1924)16 proposed qualitative genetic method to study

inheritance of fingerprints characteristics. She studied various aspects of

inheritance and embryological process leading to expression of particular

configurations

Cummins H (1936)27 professor of Anatomy at Turan University was the

first person to show the possible use of dermatoglyphics in clinical medicine.

He noted characteristic dermatoglyphic features on palms and finger in a

group of 60 patients with mongolism, which were of great value in the

diagnosis.

Penrose LS (1968)89 has drafted the memorandum on

dermatoglyphics nomenclature.

2. DERMATOGLYPHICS AND EMBRYOLOGY - DEVELOPMENT OF

THE EPIDERMAL RIDGES:

Skin consists of outer layer of epidermis and inner layer of dermis,

which differs structurally and developmentally. On palms and soles, skin is

specialized and is called friction ridge skin. The basal layer shows more

pronounced undulations and patterning known as ridges and furrows, which

produce fingerprints. They are also responsible for the palm prints.

The truth universally acknowledged is that there are no two persons in

the world who share an identical set of fingerprint patterns. No two identical

sets of fingerprints have been found. The pattern formed by the ridge

structure of skin never changes except in size during the life span of a person.


The thickness of skin for adults on the ball of finger is approximately

1/25 or 2/25 of an inch thick. The width of a fingerprint ridge is approximately

1/50 of an inch for men and slightly less in women. The width in children is

somewhat smaller than that in women. Men tend to have coarser patterns of

fingerprints ridges and there is general relationship between the height of an

individual and width of fingerprint ridges.

Destruction of friction ridges may occur during life and may be

temporary or permanent. Injury affecting only the upper layers of the

epidermis will produce temporary damage. With temporary damage the ridges

will eventually return to their original pattern. Extreme damage results in

permanent destruction of the ridges.

The science of dermatoglyphics involves the study of epidermal ridges

present on the volar surface of palms, finger, soles and toes. These epidermal

ridges form well defined patterns that characterize an individual and are very

useful in many hereditary diseases.

Development of epidermal ridges:

Differentiation of epidermal ridges takes place early in foetal

development. The ridge configurations are genetically determined and are

influenced by environmental factors. There exists relationship between

epidermal ridges and fetal volar pads because in the course of development,

ridge patterns are formed at the sites of these pads.

Bonnevie K (1924)16 postulated that the presence of the volar pads as

well as their size and positions are responsible for the configurations of

papillary ridge patterns.


Foetal volar pads are mound shaped elevations of mesenchymal tissue

situated above the proximal end of the most distal metacarpal bone on each

finger, in each interdigital area, in thenar and hypothenar areas of the palms.

Secondary feotal pads may be found on the central palm or as pairs on the

proximal phalanges. The formation of these pads is first visible on the

fingertips in the sixth to seventh week of embryonic development. During the

twelfth and thirteenth weeks, while the pads begin to regress in relative size,

the ridges begin to develop at the dermal-epidermal junction while the surface

remains smooth. These primary dermal ridge subdivide to form more parallel

ridges through the seventeenth week. During the twentieth week, the

underlying patterns become reflected by identical configurations on the skin

surface. (Mulvhill and Smith, 1969)76

Babler JW (1978)7 reported that ridge formation in the foetus begins at

about three months of intrauterine life when the volar pads are at or near their

peak development, and completed by sixth month of intrauterine life, when the

sweat gland formation and keratinization have began.

Cummins H (1936)27 speculated that the dermal ridge configurations

were the result of physical and topographical growth forces. It is believed that

tension and pressure in the skin during early embryogenesis determines the

direction of epidermal ridges.

Bonnevie K (1929)17 postulated that the patterns depend on the

underlying arrangement of peripheral nerves.


Penrose LS (1969)90 suggested that the ridges followed the lines of

greatest convexity in the embryonic epidermis.

Hirsch and Schweichel (1973)53 investigated the development

mechanism responsible for ridge formation. They also pointed out the

regularity in the arrangement of blood vessels, nerve pairs under the smooth

epidermis-corium border which exists before the formation of glandular folds

and its relationship with the growth of epidermal ridges i.e. absence of

development of ridges or abnormal ridges when nerves fail to grow into the

epithelium.

Schaumann and Alter (1976)109 pointed out that besides nerve and

blood vessels, there are so many factors such as inadequate supply of

oxygen to the tissue, deviations in the formation and distribution of sweat

glands, disturbances in the proliferation of the epithelial basal layer and

disturbances in keratinization of epithelium as other factors that may influence

epidermal ridge pattern. They also stated that environmental factors such as

external pressure on the foetal pads and embryonic foetal finger movement

could influence ridge formation.

3. DERMATOGLYPHICS AND GENETICS:

Galton F (1892)39 and Wilder HH (1902)129 were the first to study the

hereditary basis of dermal patterns, suggesting that these ridge patterns are

under genetic influence.


Rife (1954)106 observed that Europeans, Brown Caucasoid and Indians

showed highest frequency of patterns in hypothenar area. Africans and

Mongolians showed highest frequency in the fourth interdigital pattern. Lowest

frequency of patterns in hypothenar area was seen in Africans, thenar and Ist

interdigital patterns in American Indians, second interdigital patterns in

Negroes and third interdigital pattern in Europeans.

Uchida IA et al. (1962)121 observed that dermatoglyphics has been

useful in differentiation between monozygotic and dizygotic twins. It is used

for diagnosis of Mongolism. They are first to demonstrate distinctive dermal

ridge patterns in Trisomy as low TFRC.

Basu A (1976) 9, studied digital pattern and digital ridge count in there

endogamous castes in Mysore. He observed high frequency of loops,

moderate whorls and low arches. In pattern types, differences between sexes

are highly significant. Total ridge count differences between sexes are not

significant.

4. DERMATOGLYPHICS IN OTHER DISEASES:

Blotevogel (1933)15 studied fingerprints in Neurofibromatosis. He

noticed increase frequency of central pocket whorls with 13 out of 27 patients

showed one or more central pockets on the little fingers of both hands and left

ring finger.

Cummins H (1936)27 noted characteristics dermatoglyphic features in

mongolism. There is decrease frequency of whorls and increase in ulnar


loops; a single transverse palmer crease; wide atd angle; significant deviation

of axial triradii; increased frequency of patterns in hypothenar, second and

third interdigital areas; and more common simian line as compared to non-

mongols.

Brown and Paskind (1940)18 compared dermatoglyphic features of

mentally deteriorated and non-deteriorated epileptics. Arches are increased

and whorls are decreased in deteriorated group with least variation between

males and females.

Uchida IA et al. (1962)121 observed increased frequency of arches,

absence of digital flexion crease, maximum ‘atd’ angle and higher position of

axial triradii in trisomy 18 and trisomy 21.

Penrose LS (1963)87 found that trisomy 13 is associated with distal

axial triradius, 108 degrees ‘atd’ angle, and extra pattern in thenar region.

Holt SB and Lindstein J (1964)54 found ‘atd’ angle increased by 10

degrees than normal and high ‘a-b’ ridge count in Turner’s syndrome.

Alter M (1966)2 has given the detailed account of the important

dermatoglyphic analysis as a diagnostic tool for various pathological

conditions and chromosomal disorders.

Penrose (1968)89 concluded that finger patterns have low ridge counts

in Klienfilter’s Syndrome.

Mutalik GS and Lokhandwala VA (1968)77 had claimed

dermatoglyphic analysis as a simple, inexpensive and bed side diagnostic tool

for conditions due to chromosomal aberrations and various heritable disease.


Alter M and Schulenberg R (1970)1 found that atd angle was

significantly increased in all types of Congenital Heart Disease except

endocardial fibroelastosis and atrial septal defect.

Chaube R (1977)21 observed that palmer flexion creases of cancer and

tuberculosis patients are significantly different from those of the control

population.

Annapurna V et al. (1978)5 studied dermatoglyphics in rheumatic

heart disease. There was decreased frequency of arches finger tip pattern in

males and increased frequency of whorls in females. There was also

increased frequency of patterns in 3rd interdigital area in males and decreased

td ridge count and increased multiple axial triradii in females.

Purandare H et al. (1978)95 studied dermatoglyphic pattern in

idiopathic mentally retarded children. They found low TRC, higher atd angle,

and increased frequency of hypothenar pattern.

Sant SM et al. (1980)107 studied dermatoglyphic traits in diabetic

patients and observed that there were increased frequency of whorls and

decreased ulnar loop; increased frequency of Sydney line; and increased

frequency of arches in female.

David TJ (1981)28 studied dermatoglyphics in congenital heart disease

and noticed overall increase incidence of hypothenar pattern with increase atd

angle.


Reed T (1981)104 reviewed dermatoglyphic findings in patients with

chromosomal abnormalities and opined that it helps in the diagnosis of

patients with suspected chromosomal abnormalities.

Pal GP et al. (1985)82 observed significant decrease frequency of ulnar

loop and increase in arches on fingertips of carcinoma of cervix patients with

increase atd angle, decrease TFRC and decrease frequency of 3rd interdigital

palmar patterns.

Weinreb HJ (1985)126 studied fingerprint patterns in Alzheimer’s

disease. There was significant increased frequency of ulnar loops and

decreased frequency of whorls and arches. A pattern of eight or more ulnar

loops was found significantly more often in patients (72%) than in the control

group (26%). Radial loops on the fourth and fifth digits were more prevalent in

patients. These patterns observed in Alzheimer disease are congruent with

patterns repeatedly found in Down’s syndrome, and support the known

associations between these two diseases at a further level.

Nair Renuka (1986)79 studied dermatoglyphics in different types of

congenital heart disease. There was increased frequency of Sydney line in

VSD, TOF and other cyanotic malformations. Distal displacement of axial

triradius was significantly increased in PDA. Absence of C-triradius was

significantly increased in TOF. Decrease frequency of loop fingertip patterns

in ASD and NCM and increase frequency of loop in TOF and Congenital

Malformation in male congenital heart disease. Whereas increase frequency

of loop fingertip pattern and decrease frequency of whorls was observed in

VSD in female congenital heart disease.


Gupta CM and Tutakne MA (1986)42 in their study found significant

high frequency (p<0.001) of palmer pattern in thenar and 1st interdigital area

on left palm of “Multibacillary Leprosy” patients with slight increase in

frequency of distal axial triradii.

Jamison CS (1988)59 observed higher left ab ridge count, wider atd

angles in both sexes, and higher frequency of palmer pattern in left 4 th ID area

with more distally located axial triradii in dyslexics patient.

Pursnani ML et al. (1989)97 studied palmer dermatoglyphics in

essential hypertension. Significantly dermatoglyphic findings observed in both

sexes of hypertensive patients as compared to controls subjects were i)

Increase TFRC ii) Decrease frequency of axial triradius t in right palm female

and t’ & t” in right palm male. iii) Decrease atd angle iv) Absence of axial

triradii in both palms in 10% cases & in none of the controls.

Smahel Z and Gregor P (1989)113 found significant increase in the

frequency of double loops on the finger in patients with hypertrophic

cardiomyopathy and the main palmar line had a more longitudinal course on

the palm with its termination more frequently in area 3, less frequently in area

5 than in control group.

Pallotta R et al. (1989)83 studied dermatoglyphic traits in 27 patients

with neurofibromatosis type I. The frequency of digital central pocket whorls

was significantly greater, particularly on finger 2, 4, and 5th digit of female with

increase TFRC and ab ridge count. The atd angle was increased in both

hands of female and on right hand in males.


Polyzova D et al. (1991)92 studied dermatoglyphic features in

hypertensive patients. They observed lower frequency of ulnar loop fingertip

pattern and higher frequency of whorls in hypertensive patients with increased

total finger ridge count (TFRC) and atd angle.

Ziegler AG et al. (1993)131 noticed that type I diabetic patients had a

lower 3rd finger ridge count and ab ridge count as compared to the controls.

They also found higher frequency of palmar axial t’ and t” Triradii and a lower

frequency of true palmar pattern in 4th interdigital area in diabetic patients.

Verma SL et al. (1995)122 studied fingerprint patterns in Schizophrenic

patients and found increase frequency of loops and whorls in all digits as

compared to the controls but not statistically significant.

Chiba T et al. (1995)22 found increase frequency of arches and radial

loops on both thumbs, ring fingers and little fingers of patient with biliary

atresia than on those of normal person.

Ravindranath R and Thomas IM (1995)102 studied dermatoglyphics in

maturity onset diabetes mellitus. There was decrease in the mean value of

TFRC and AFRC but not statistically significant in both sexes. Male and

female diabetics showed a significant increase in frequency of ulnar loops,

radial loops and arches and a decrease frequency of whorls.

Rajangam S et al. (1995)98 obtained dermatoglyphic data from 235

cytogenetically confirmed patients of Down’s syndrome. Analysis revealed

increased frequency of ulnar loop fingertip pattern with decreased TFRC and

wider atd angle in patients. Sydney line, Simian crease and patterns in the


hypothenar and interdigital areas have occurred more frequently in the

patients.

Premalatha S (1995)94 noticed increased frequency of ulnar loop

pattern over finger tips in both sexes having ‘Neurofibromatosis’ with

significant reduction in mean ab ridge count in females.

Reed T (1995)105 studied dermatoglyphic features in 308 hypertensive

individual to compare with 316 normotensive normal controls. It was found

that then were no useful or strong relationships between dermatoglyphics

features (like FT patterns, ridge count total / absolute, atd angle, ab ridge

count) and hypertensive individual.

Floris G and Marini E (1998)36 studied dermatoglyphics in individual

suffering from essential hypertension. There was increase frequency of whorls

and increase TFRC with more frequent absence of triradius t.

Simsek S et al. (1998)111 studied dermatoglyphics in children with

cerebral palsy. They reported increased frequency of arch, radial loop and

whorl patterns and decreased frequency of ulnar loop in boys and girls but

statistically significant in boys. There was also decrease in TFRC and ab ridge

count (significantly in boys), but increased in atd angle in patient as compared

to the control group.

Stevenson CJ et al. (2001)114 found no statistically significant

correlations of finger print patterns and atd angle in hypertensive individuals.

Igbigbi PS et al. (2001)56 studied dermatoglyphic features of 99

Malawian patients with diabetes, hypertension and diabetes + hypertension. It


was found that the most predominant ridge pattern were arches in all patients

followed by loops. In diabetes alone, arches were absent; in hypertension, the

arches were only present in women.

Pattanaik L et al. (2002)85 revealed that 56% cases fingertips show

whorls and in 63% cases atd angles fall between the range of 41-46 degree in

bronchial asthmatic patients.

Mokashi V and Kantha S (2002)75 found increase total and absolute

finger ridge count in patient having essential hypertension with decrease in

atd angle. There was also increase in the frequency of whorls and decrease in

the frequency of arches and radial loops.

Ranganath P et al. (2003)99 carried out work on quantitative

dermatoglyphics in hypertension. They found that there was increase in ridge

count in 1st digit of right hand in male. The atd angle was increased in male

and decreased in female hypertensive patients as compared to controls.

Gupta UK et al. (2003)48 studied fingertip patterns in bronchial asthma

and its genetic predisposition. Higher frequency of whorls was observed in 1st

digit in patient as compared to controls. There was decrease frequency of

total arches as compared to controls (p<0.001).

Ravindranath R et al. (2003)103 studied dermatoglyphics in rheumatoid

arthritis. They noticed increased arches and decreased loops/ whorls and

increased simian crease in male patients. Whereas in female patients, there

was a significant increase in whorls and decrease in loops on the 1st finger of


both hands, with increase in arches on 3rd digit and whorls in 4th digit of left

hand.

Kulkarni DU and Herekar NG (2005)63 observed increase total finger

ridge count (TFRC) and decrease atd angle in patients of essential

hypertension. The other parameters like fingertip patterns, palmer patterns,

palmer crease patterns did not show any significant variation.

Babu SS et al. (2005)8 studied dermatoglyphic features in Pulmonary

Tuberculosis. There was predominance of whorl pattern (56.6%) with

decrease in loop pattern (32.1%) in tuberculosis. Also the mean TFRC and

AFRC were significantly higher with narrower atd angle when compared to

controls.

Kulkarni PR et al (2006)64 studied dermatoglyphics in Congenital

Talipus equinovarus and observed decrease frequency of ulnar loops and

increase frequency of whorls in both hands.

Inamdar VV et al. (2006)57 studied dermatoglyphic features in

carcinoma cervix and observed significant increase in the frequency of whorls

in both hands and arches in left hand. They also noticed increase TFRC and

decrease atd angle, td ridge count and decrease frequency of ulnar loops in

both hands.

Ana Tarca (2006)3 studied dermatoglyphic in NIDDM (Type 2 DM) and

found partial or total suppression of line C (Cx / Co), reduced ab ridge count,

increase frequency of ulnar loop in hypothenar and absence of t triradius.


Chintamani et al. (2007)23 conducted a dermatoglyphic study on 60

histopathologically confirmed breast cancer patient and compared with

controls. They observed that six or more whorls in the total fingertip pattern

were statistically significant among cancer patient as compared to controls.

There was also increase frequency of whorls in right ring finger and right little

finger as compared to the controls.

Kumbnani HK (2007)66 cited absence of finger and palm prints in one

and the only case afflicted with Naggely Syndrome Dermatopathia

pigmentosa reported by the Times of India in 2000.

Oladipo GS et al. (2007)81 studied dermatoglyphic analysis of 90 sickle

cell anaemia cases and observed decrease frequency of ulnar loop and

increase frequency of whorl fingertip patterns, but not statistically significant.

The atd angle, ab ridge count and position of axial triradius were almost same

in both groups, however 2.2% of the cases had Sidney creases.

II. CORONARY ARTERY DISEASE: (CAD)

Synonyms: Coronary Heart Disease (CHD), Atherosclerotic Heart Disease

(AHD), Ischemic Heart Disease (IHD)

CAD is the end result of the accumulation of atheromatous plaques

within the walls of the arteries that supply the myocardium with oxygen and

nutrients leading to myocardial ischemia. It is the most common cause of

sudden death.


In India, CVD accounted for 32% of all deaths in 2000, and the WHO

estimated that 60% of the world’s cardiac patients will be Indian by 2010. The

transition appears to be in the western style, with CHD as the dominant form

of CVD. (Kumar V et al., 2007)65

EPIDEMIOLOGY:

Coronary Artery Disease (CAD) in its various forms is the leading

cause of death for both males and females in the United States and other

industrialized nations. Each year, near 500,000 Americans die of CAD. About

1.5 million individuals in the US suffer an acute myocardial infarction annually

and approximately one third of them die. At least 250,000 people a year die of

a heart attack before they reach the hospital. (Kumar V et al., 2007)65

CAD is the leading cause of cardiovascular mortality worldwide, with

>4.5 million deaths occurring in the developing world. Despite a recent decline

in developed countries, both CAD mortality and the prevalence of CAD risk

factors continue to rise rapidly in developing countries. (Okrainec K et al,

2004)80

Cardiovascular disease will likely become a major public health and

clinical problem in South Asia (India, Pakistan, Bangladesh, Nepal). Estimates

from the Global Burden of Disease Study suggest that by the year 2020 India

will have more individuals with athero-thrombotic cardiovascular disease than

any other region. (Yusuf and Ounpuu, 2001)130


Clinical Manifestation: IHD is invariably caused by disease affecting the

coronary arteries, the most prevalent being atherosclerosis accounting for

more than 90% cases, while other causes are responsible for less than 10%

cases of IHD. (Harsh Mohan, 2006)50. The clinical manifestation of CAD is

generally due to progressive encroachment of the lumen leading to stenosis

or to acute plaque disruption with thrombosis, which compromises blood flow.

A fixed obstructive lesion of 75% or greater generally causes symptomatic

ischemia induced by exercise and 90% stenosis can lead to inadequate

coronary blood flow even at rest. Slowly developing occlusions may stimulate

collateral vessels over time, which protect against distal myocardial ischemia

and infarction even with an eventual high-grade stenosis. (Kumar V et al.,

2007)65

The Clinical Manifestations of IHD can be divided into four syndromes:

(Kumar V et al., 2007)65

I] Angina Pectoris, in which the ischemia is less severe and does not

cause death of cardiac muscle. Of the three variants – stable angina,

Prinzmetal angina, and unstable angina; the latter is the most threatening as a

frequent harbinger of Myocardial Infarction.

II] Myocardial Infarction (MI), the most important form of IHD, in

which the duration and severity of ischemia is sufficient to cause death of

heart muscle.

III] Chronic Ischemic Heart Disease with heart failure.

IV] Sudden Cardiac Death.


Acute Coronary Syndromes: Acute MI, unstable angina and sudden cardiac

death are sometimes referred to as acute coronary syndromes.

The first coronary presentation for women is more likely to be an angina,

whereas in men it is more likely to be MI. Diabetic men and hypertensive

person of both sexes are particularly susceptible to silent or unrecognised

myocardial infarctions. (Fuster V et al., 2001)37

RISK FACTORS OF CAD:

The concept of Cardiovascular risk factors arose from the

FRAMINGHAM HEART STUDY, a landmark study in CVD epidemiology,

which is based on the traditional risk factors of age, sex, dyslipidemia, blood

pressure and smoking. (Kannel WB et al., 1961)61

The aetiology of CAD is multifactorial. Apart from the obvious ones

such as increasing age and male sex, studies have identified several

important “risk” factors. Some are modifiable, other not. Presence of any one

of the risk factors places an individual in a high risk category for developing

CAD. The greater the number of risk factors present, the more likely one is to

develop CAD. (Park K, 2007)84

Risk Factors for CHD are as follows:

NOT MODIFIABLE MODIFIABLE

Age Cigarette smoking

Sex Hypertension


Family History Diabetes – Hyperinsulinemia

Genetic Factors Hypercholesterolemia – elevated serum

cholesterol

Personality Obesity

Sedentary Habits

Stress

1. Smoking: It is responsible for 25% CHD deaths under 65 years of age

in men.

2. Hypertension: It accelerates the atherosclerotic process, especially if

hyperlipidemia is also present.

3. Serum Cholesterol: Increase level of serum total cholesterol (TC),

usually > 220 mg/dl, increases the risk for the development of MI. There is a

triangular relationship between habitual diet, blood cholesterol- lipoprotein

levels and CHD. Japan is having the lowest incidence and Finland is having

the highest incidence of CHD, because of the cultural differences in serum

cholesterol level between two countries. Low density Lipoprotein (LDL)

cholesterol is most directly related with CHD. While very low density

lipoprotein (VLDL) has been shown to be associated with premature

atherosclerosis. Whereas, High Density Lipoprotein (HDL) cholesterol (>30

mg/dl) is protective against the development of CHD. Total cholesterol/ HDL

ratio of <3.5 has been recommended as a clinical goal for CHD prevention.


4. Diabetes: The risk of CHD is 2-3 times higher in diabetes than in non-

diabetics. CHD is responsible for 30-50% of deaths in diabetics over the age

of 40 years in industrialized countries.

5. Genetic Factors: A family history of CHD is known to increase the risk

of premature deaths. Genetic factors are probably the most important

determinants of a given individual’s TC and LDL levels.

6. Physical Activity: Sedentary life style is associated with a greater risk

of the development of early CHD.

7. Personality: Type A behaviour is associated with competitive drive,

restlessness, hostility and a sense of urgency or impatience. Type A

individuals are more prone to CHD than the calmer, more philosophical Type

B individuals.

8. Alcohol: High alcohol intake of >75 gm/day is an independent risk

factor for CHD and hypertension.

In India, the prevalence of NIDDM is very high. Hypertension

contributes significantly to morbidity and mortality in NIDDM. About 30-50% of

the NIDDM patients have hypertension. Conversely, approximately 50% of

hypertensive individuals are estimated to have hyperinsulinemia.

Hyperinsulinemia may directly produce deleterious changes in metabolic

activity of arterial wall cells. It is also associated with increased total

cholesterol, VLDL and triglycerides, decrease HDL and alteration in LDL

composition and density resulting in more atherogenic particles. (Premalatha

G and Mohan V, 1995)93.


The CAD and coronary risk factors were 2-3 fold more common among

urban subjects compared to the rural population in both sexes. Central obesity

was four times more common in the urban population compared to the rural in

both sexes. Sedentary life style and alcohol intake were significantly higher in

urban population. (Singh RB et al, 1997)112

There was a significant association between CAD and age,

hypercholesterolaemia, hypertension and central obesity in both sexes.

(Singh RB et al, 1997)112

In more recent Prospective Cardiovascular Munster (PROCAM) 8 risk

variables are identified as age, family history of premature MI, Diabetes,

Hypertension – systolic BP, Smoking, LDL- Cholesterol, HDL- Cholesterol,

and triglycerides. (Assmann G et al, 2000)6. Lipoprotein-a, Homocysteine,

Fibrinogen, and hsCRP are also identified as the risk factors of CAD.

Chamber JC et al. (2000)20 reported that plasma homocysteine is an

independent risk factor for CAD in Asian Indians compared to Europeans.

CAD is closely associated with diabetes and hypertension. The risk of

CAD is 2-3 times higher in diabetic than non diabetic. (Yusuf et al., 2001)130.

Nair KG et al. (2002)78 reported that methylene tetra-hydrofolate

reductase (MTHFR) gene mutation causing hyperhomocysteinemia as a risk

for increased risk for CAD in Indians.

The risk of CAD is 2-3 times higher in diabetes than in non-diabetics.

CHD is responsible for 30-50% of deaths in diabetics over the age of 40 years


in industrialized countries. Hypertension accelerates the atherosclerotic

process, especially if hyperlipidemia is also present. (Park, 2007)84

Harish Rao et al. (2007)49 obtained a very high sensitivity, specificity

and accuracy with above 90% positive prediction value for increase plasma

homocysteine levels in CHD patients when compared to commonest

conventional risk factors. Elevated plasma homocysteine may be an important

cause for atherosclerosis formation.

The increasing frequency of CAD in the young suggests the possible

role of non-conventional risk factors. In a case control study it was found that

High C reactive protein levels and Ig G anti-chlamydial antibodies are

significantly associated with CAD in Indians. However, insulin, lipoprotein A,

fibrinogen, Ig G anti-chlamydial antibodies and higher levels of total plasma

homocysteine have no statistically association with CAD. (Jaswal DS et al.,

2008)60

INCIDENCE AND PREVALENCE OF CAD:

In the US, an estimated 12 million people have CHD, about one half of

whom have acute MI and half have angina pectoris. For men the prevalence

of MI is 1% at ages 35-44 years and 16% at ages 75 and over. In women, the

prevalence is less than 1% at ages 35-44 years and 13% at ages 75 and

over. (Fuster V et al., 2001)37

In the US, CHD causes about 650,000 new heart attacks each year

and 450,000 recurrent attacks. The incidence in women lags behind that in


men by 10 years for total CHD and by 20 years for more serious clinical

manifestations such as MI and sudden death. (Fuster V et al., 2001)37

Gensini GG et al. (1972)40 in New York observed an incidence of 4.5%

CAD in a group of 278 adults undergoing cardiac catheterization with the

clinical diagnosis of valvular or congenital heart disease in absence of

symptoms suspicious for CAD.

Postmortem analysis of asymptomatic patients who died of causes

unrelated to CAD pointed to an estimated prevalence of 4.5% of CAD, 6.4% in

men and 2.6% in women. (Diamond and Forrester, 1979)31.

In Germany, the prevalence of CAD was 7.3% in patient in whom the

underlying disease was not related to CAD and who underwent coronary

angiography as part of their routine baseline evaluation. The mean levels of

total cholesterol and other risk factors were not significantly different in patient

with CAD compared with those without. But the levels of LDL cholesterol and

Lipoprotein-a were significantly higher and HDL cholesterol lower in CAD.

(Enbergs A et al., 2000)32

The prevalence of CAD was approximately 10% between 25-64 years

of age in most of the developed countries, which may be slightly higher in the

United States and Northern Europe and lower in Southern Europe, Japan and

Australia. (Mandal S et al., 2009)70

At least three studies from UK have confirmed that prevalence of CAD

is several fold higher among Asian Indians, more particularly at younger age


of 25-39 years, whereas it rarely occurs below the age of 40 years among

Europeans. (Premalatha G and Mohan V, 1995)93.

About two thirds of the global estimated 14.3 million annual

Cardiovascular disease (CVD) deaths occur in the developing world. By the

year 2015, CVD could be the most important cause of mortality in India. The

prevalence of CAD increased from 1% in 1960 to 9.6% in 1995 in urban

populations, and in rural areas it has almost doubled in the last decade.

(Gupta R and Gupta VP, 1996)43

The overall prevalence of CAD, based on a clinical diagnosis and an

electrocardiogram (ECG) was 9.0% in the urban and 3.3% in the rural

population of Moradabad district of North India with significantly (P<0.001)

higher prevalences in the men compared with women in both urban (11.0 vs 6.9)

and rural (3.9 vs 2.6%) populations respectively. (Singh RB et al., 1997)112

The Prevalence of CAD in different regions of India is as follows:

Sr. Authors Year Published in Region Popul Sample Preval

1. Mandal et al 70 2009 Ind J Com Med,Siliguri Urban 250 11.6%

2. Latheef et al 68 2006 Ind Heart J Tirupati Urban 1519 12.6%

3. Gupta R et al 46 2002 Ind Heart J Jaipur Urban 1123 08.2%

4. Mohan V et al 74 2001 J A C Cardiol, Chennai Urban 1263 11.0%

5. Gupta R et al 45 1995 Ind Heart J Jaipur, Raj. Urban -- 07.6%

6. Beegom R et al 10 1995 Acta Cardiol Trivandrum Urban 506 13.9%

7. Gupta R et al 44 1994 Br Med J Jaipur Rural 1905 04.6%


8. Wander G et al125 1994 Ind Heart J Ludhiana Rural -- 03.8%

9. Kutty R et al 67 1993 Int J Cardiol Trivandrum Rural 1130 07.4%

10. Chadda et al 19 1990 Ind Heart J Delhi Urban 13275 09.7%

11. Gupta SP et al 47 1975 JAPI Rohtak Urban -- 03.8%

12. Sarvotham et al1081968 Circulation Chan’garh Urban -- 06.6%

The prevalence of CAD reported in different studies showed that

prevalence of CAD has almost doubled in rural areas and increased 9-fold in

the urban population, and that the rates are higher in South India as

compared to the North. The prevalence of CAD and coronary risk factors is

high in urban population in India as compared to rural population. (Mandal S

et al., 2009)70.

GENETIC CORRELATION:

CAD and MI are significantly determined by genetic background

(Fischer M et al, 2005)35. Heredity exerts a major influence on the

development of some of the established risk factors, such as hypertension,

diabetes mellitus, and hypercholesterolemia, but the role of independent

genetic influences through mechanism other than these known risk factors

remains unknown. Stone PH et al. (1981)115 found that there is statistically

significant association between HLA BW38 and presence of CAD, found in

21% cases as compared to 4% in control population.


The manifestation of CAD is influenced by a complex interplay of

numerous environmental and genetic factors. With regard to the genetic

contribution, a positive family history for MI is considered to be strong

cardiovascular risk factors. At younger ages, death from CAD is influenced by

genetic factors in both sexes. The death from CAD at an early age in one’s

twin was a strong predictor of the risk of death from this disorder. The risk was

greater in monozygotic twins than in dizygotic twins and was largely

independent of other personal risk factors for CAD. (Marenberg ME et al.,

1994)71.

Several genetic polymorphisms are associated with risk factor level

and/or CHD, and genes have a significant effect on the level of several risk or

"anti-risk" factors. Lp(a) lipoprotein, which exhibits a definite association with

CHD, is under strict genetic control. A high level of Lp(a) lipoprotein does not

in itself result in increased lipid levels, and it is therefore necessary to conduct

specific tests with regard to this important genetic risk factor. DNA variation at

several apolipoprotein loci has been examined and several associations with

risk factor levels have been reported. (Berg K, 1989)12.

Polzik EV et al. (1993) 91 opined that the two genetic markers--HLA

antigens and the pattern of dermatoglyphics- provide strong evidence for the

fact that there is a genetic predisposition to coronary heart disease. However

the dermatoglyphic pattern has been found to be a more reliable marker of

predisposition to this disease than HLA antigens.

Kassem NS et al. (1994)62 conducted the study aimed at studying

certain genetic markers (lipoproteins, ABO blood groups and


dermatoglyphics), in cases of CHD patients and control group to detect any

significant association between such genetics markers in this disorder. The

study revealed significant and marked association of CHD with low alpha-

lipoprotein, high pre-beta and beta-lipoproteins. No significant association was

detected with ABO phenotypes. Definite significant association was also

detected between CHD and certain dermatoglyphics phenotypes including

FTP, T-D count and palm patterns. These significant associations of CHD and

these genetic markers "which are genetically determined" denoted strongly

genetic etiology or at least genetic predisposition of CHD.

Golabi P et al. (1999)41 carried out a case-control study on patients of

myocardial infarction to determine the association of haptoglobin (Hp),

transferrin (Tf) and complement component 3 (C3) polymorphism with

myocardial infarction. It was noted that Tf and C3 polymorphism was found to

be statistically non-significant while the Hp polymorphism was found to be

statistically significant (chi sq = 21.88, p < 0.01) in cases of MI.

Atherosclerotic involvement in the coronary arteries, which can result in

heart attack and sudden death, is a common disease and prototypic of a

complex human trait. Although there was limited inter-study concordance of

important loci, two gene variants in the leukotriene pathway (ALOX5AP and

LTA4) have emerged as susceptibility factors for myocardial infarction (MI).

Genome-wide association studies have also been undertaken, and the pro-

inflammatory cytokine lymphotoxin-alpha (LTA), and its key ligand galectin-2

(LGALS2) have been identified as genes implicated in predisposition for heart

attack. (Topol EJ et al., 2006)120


DIGNOSTIC PROCEDURE: CORONARY ANGIOGRAPHY

While the aspect of cardiac catherterization may be performed in

specific clinical situations, the essence of modern catheterisation is high-

quality coronary angiography. The tips of specially shaped catheters are

placed into left and then to the right coronary artery, and any surgical bypass

grafts, under fluoroscopic guidance. Hand injection of a radiographic contrast

agent allows opacification of their lumina, with those images recorded at 15

frames per second on a radiographic image (cine angiography). Each

coronary artery is usually viewed in several projections to permit assessment

of the location and severity of any stenosis relative to the adjacent “normal”

vessel segments. It also evaluates the rapidity of coronary flow, the blush of

capillary filling in the myocardium, collateral pathways that perfuse myocardial

territories supplied by an occluded vessel, the presence of congenital

abnormalities of the coronary circulation (e.g. coronary fistula), and patency of

any previously constructed coronary artery bypass graft. The degree of

stenosis is typically evaluated by visual estimation of percent diameter

stenosis of each lesion relative to the “uninvolved” adjacent reference

segment. Despite recent progress in multidetector computed tomography

(MDCT) that suggests this evolving technique may ultimately replace

screening pre-surgical coronary angiography, coronary arteriography remains

the most diagnostic tool for evaluation of the coronary anatomy in with

sufficient precision to inform decisions regarding coronary surgery vs. catheter

based interventions in patients with CAD (Fauci AS et al., 2008)33.


Coronary Angiography, a diagnostic procedure for CAD is

recommended only when non-invasive diagnostic procedure are suspicious of

CAD or the patient presents with a high risk profile of cardiovascular risk

factors (e.g. serum Cholesterol >300mg/dl, excessive smoking, etc) or in

patients with a history of CAD or with clinical symptoms typical for this

disease. (Enbergs A et al, 2000)32

Coronary angiography is still the gold standard for the detection of

significant coronary atherosclerosis. Due to its invasive nature, it is not

possible to use it for screening entirely asymptomatic (healthy) populations.

(Widimsky and Andel, 2000)127

INVOLVEMENT OF CORONARY ARTERIES BY ATHEROSCLEROSIS:

Atherosclerotic lesions in coronary arteries are distributed in one or

more of the three major coronary arterial trunks, the highest incidence being

in left anterior descending artery (LAD), followed by right coronary artery

(RAC) and left circumflex artery (LCX). (Harsh Mohan, 2006)50

Kumar V et al. (2007)65 also described that although only a single major

coronary epicardial trunk may be affected, two or all three – LAD, LCX, and

RCA are often involved. Clinically significant stenosing plaques may be

located anywhere within these vessels but tend to predominate within the first

several centimeters of LAD and LCX and along the entire length of the RCA.

Sometimes the major secondary epicardial branches are also involved (i.e.

the diagonal branches of LAD, obtuse marginal branches of LCX or posterior


descending branch of RCA), but atherosclerosis of the intramural branches is

rare.

Autopsy in individuals who died of non cardiac causes revealed a high

prevalence of SVD up to 10%. (Davies MJ, 1992)29.

The frequency of TVD is more common in Asian Indians as compared

to Europeans, which suggests that severity of LAD is greater in Asian Indians.

(Premalatha G and Mohan V, 1995)93.

Enbergs A et al. (2000)32 studied 331 patients in whom the underlying

disease was not related to CAD and found a prevalence of CAD in 7.3%

cases with SVD in 3.6%, DVD in 2.1% and TVD in 1.6% with at least one

critical stenosis greater than 50% lumen.

Among patients with unstable angina who undergo coronary

angiography, ~25% will have one vessel, 25% have two vessels and 25%

have three vessels involvement, 10% will have significant left main stenosis

and the other 15% will have narrowing of less than 50% or normal vessel on

angiography. (Fuster V et al., 2001)37

Fischer M et al. (2005)35 noticed atherosclerotic lesion to an extent of >

50% stenosis in 23.1% cases having SVD, 33.1% cases having DVD and

40.3% cases having TVD.

About one third of cases of CAD have single vessel disease (SVD),

most often LAD arterial involvement; another one third have two vessels

disease (DVD), and the remainder have three major vessels disease (TVD).

(Harsh Mohan, 2006)50.


III. DERMATOGLYPHICS IN CORONARY ARTERY DISEASE:

Takashina T et al. (1966)116 studied palmer dermatoglyphic patterns

on 44 patients with congenital heart disease and compared with patterns on

362 patients with acquired heart disease. Distal displacement (t” or multiple

axial triradii) of the palmer axial triradii occurred significantly greater frequency

in the patients with congenital heart disease (64%) as compared to acquired

heart disease (17%). Significant increase in the loop pattern in hypothenar

area in acquired heart disease (33%) as compared to congenital heart

disease (21%). However there was increase percentage frequency of palmar/

tented arches in congenital heart disease (79%) as compared to acquired

heart disease (65%).

Rashad and Mi (1975)100 carried out dermatoglyphic studies on 800

Japanese subjects. Individuals with MI had a significantly higher finger of true

whorls and a correspondingly lower frequency of ulnar loops than the control

group. Total and absolute ridge counts were also significantly higher in MI.

However individuals with HT were not significantly different in most

dermatoglyphic triats from the controls.

Rashad et al. (1978)101 observed that individuals who had had MI were

significantly higher in total and absolute ridge counts than other control. There

was also an increase frequency of true whorls with a proportional decrease in

the frequency of ulnar loops. The MI patients had significantly higher

frequency of true whorls, double loops and less ulnar loops and tented

arches. Total and absolute ridge counts were significantly higher (P<0.05) in

all digits in favour of MI patients.


Anderson MW et al. (1981)4 studied an association between

Dermatoglyphic features and MI in the caucasian males. It was found that

there was no statistically significant difference in finger pattern type

frequencies between MI and control subjects. Nor did the analysis of the total

and absolute ridge count distribution in MI patient.

Bhatt SH (1996)13 presented data showing significantly higher

incidence of whorls and lower incidence of loops in patients with MI.

Shamsadini S et al. (1997)110 studied 100 patients of MI and 100

controls to find out the relationship of finger dermatoglyphics in MI in man.

They revealed statistically significant increase in the frequency of loop in MI

patients when compared to the controls. They concluded that loop type finger

print compared to whorl and arch type were more associated with MI

(P<0.001). They have grouped MI in two groups as Q type MI and non Q type

MI on the basis of electrocardiography, where Q type MI was found to be

predominant.

Dhall V et al. (2000)30 studied 42 patients of MI and 42 controls. It was

observed that the total number of whorls was significantly higher in patients

with MI as compared to control group (P<0.0001), while there was significant

less number of loops in MI (P<0.0001). There was also decrease in the

percentage of arches in MI but not statistically significant. All the digit in MI

patients showed higher percentage of whorls with statistically significant in

right thumb (P<0.05), right little (P<0.01) and left ring finger (P<0.05). Also

there was decrease frequency of loops in all digits with significant in right

thumb and left ring finger in MI patient.


Jalali F et al. (2002)58 studied cross sectional study of 900 patients of

MI and 900 control group. It was noticed that in MI patients, the distribution of

dermatoglyphic pattern was 7.2% arch type, 46.8% loop type and 46% whorl

type of fingertip patterns in contrast to 30.7%, 50.7% and 45.5% respectively

in control group. Thus the arch type was significantly increased in MI as

compared to the control (P<0.001) and particularly in left thumb, left index and

left ring finger (P<0.0001). They had also grouped MI cases into Q-wave MI

and non-Q-wave MI on the basis of electrocardiography and noticed that the

percentage of arch type was significantly increased in both Q-wave and non-

Q wave MI when compared to the control (P<0.0001), however the

percentage of arch was greater in non-Q-wave MI as compared to Q-wave MI.

There was roughly two times increase in the rate of arch patterns in MI

patients.


MATERIAL AND METHODS:

The present study was carried out in the Department of Anatomy from

July 2007 to August 2009. It includes 150 patients (120 males and 30

females) of Coronary Artery Disease. Similarly equal numbers of normal

healthy individual were included as controls. Even the individuals with history/

family history of hypertension, diabetes or any cardiac problem were excluded

from controls.

All the patients were taken from the Private Cardiac Hospitals of the

region. The patients who were diagnosed after Coronary Angiography were

only included in the study. Even the patients of IHD with normal coronary

angiography were excluded from the study. The Palmar Prints of the patients

and the controls were taken on the Map Litho White paper by ink method.

METHOD OF DERMATOGLYPHIC PRINTING:

Dermatoglyphic prints were taken by the “INK METHOD” as described

by CUMMINS (1936)27 and CUMMINS and MIDLO (1961)26. This method was

selected from the various methods described in literature because of following

advantages:

1. Simple technique.

2. Low cost.

3. Clarity of Prints.

4. Being less time consuming.


MATERIAL REQUIRED: (Figure No.1)

1. Camel quick drying duplicating ink.

2. Rubber roller.

3. Inking Slab- Thick glass sheet fixed over wooden support.

4. Century board.

5. White ‘Map Litho’ paper with a glazed surface on one side.

6. Pressure pad made up of rubber foam.

7. Cotton puffs.

8. Scale.

9. Pencil Pen

10.Protractor – To measure ‘atd’ angle.

11.Needle with a sharp point, for ridge counting.

Figure No 1: Showing Materials required in Dermatoglyphic Printing


STEPS IN THE PRINTING METHOD:

1) The subjects were asked to clean their hands with soaps and water.

They were also asked to dry their hands but to leave some

moisture.

2) The requisite amount of ink daub was placed on the glass slab. It

was uniformly spread by the rubber roller to get a thin even ink film

on the glass slab.

3) The thin film of ink was applied on the palm by passing the inked

rubber roller uniformly over the palm and digits taking care that the

hollow of the palm and the flexor creases of the wrist were uniformly

inked.

4) The palm was examined for the uniformity of the ink, and if found

otherwise ink was also applied to the hollow of the palm with the

help of cotton puffs.

5) Left hand of the subject was then placed on the sheet of paper

(kept over the pressure pad) from proximal to distal end. The palm

was gently pressed between inter-metacarpal grooves at the root of

fingers, and on the dorsal side corresponding to thenar and

hypothenar regions. The palm was then lifted from the paper in

reverse order, from the distal to proximal end. The fingers were also

printed below the palmar print by rolled finger print method. The tip

of the fingers were rolled from radial to ulnar side to include all the

patterns.

6) The same procedure was repeated for right hand on separate paper.

7) The printed sheets were coded with name, age, sex, and for case

group (CAD) and control group.

8) The prints were then subjected for detail dermatoglyphic analysis

with the help of magnifying hand lens and ridge counting was done

with the help of a sharp needle. The details were noted on the same

paper with the pencil pen.


PROFORMA

Title of Research Project: Study of palmar dermatoglyphics in Coronary

Artery Disease.

Investigator: Dr.

PERSONAL DATA

Case/ control: Reg. No.:

Name of Subject: Age/ Sex:

Address:

Diagnosis:

History of DM/ HT/ Cardiac disease:

Family History:

DERMATOGLYPHIC DATA

1. Qualitative analysis of finger prints.

i) Loops :

ii) Arches :

iii) Whorls :

2. Quantitative analysis of finger prints.

i) Total finger ridge count (TFRC)

ii) Absolute finger ridge count (AFRC)

3. Palmar Patterns

4. Position of Axial Triradii

5. Number of Palmar Triradii

6. ab ridge count

7. ‘atd’ angle


MORPHOLOGY:

DERMATOGLYPHICS CONFIGURATIONS

Ridge detail (Minutiae): (Figure No. 2)

Intricate details of structure of epidermal ridges are termed as minutiae

by Galton F (1892)39. They are highly variable but unique to an individual.

They are valuable and reliable for personal identification. They do not have

other medical value.

Figure No 02: Showing Ridge Details (Minutiae)

Penrose LS (1968)89 classified the minutiae in 7 groups.

Nomenclature of Minutiae:

Island or Point: It is a very short, approximately independent circular ridge

bearing only one sweat pore.

Short Ridge: It contains 2-5 pores of sweat glands.


Fork or Y Formation: It represents bifurcation of a ridge.

Enclosures: It is formed by reunion of 2 branches of a bifurcated ridge.

End: It is an abrupt termination of the ridge.

Interstitial Line: It is a narrow subsidiary ridge in the furrows between

individual ridges. It is inconstant and omitted in ridge counting.

Pattern Configurations:

A] Fingers: 1. Fingertip Pattern configurations.

2. Dermatoglyphic landmarks.

3. Patterns of middle and proximal phalanges.

B] Palms: Palmar pattern configuration.

1. Hypothenar (Hyp) 2. Thenar (Th)

3. Interdigital area - 1st, 2nd, 3rd and 4th (ID1, ID2, ID3, ID4)

FINGERTIP PATTERN CONFIGURATION: (Figure No. 3)

Galton F (1892)39, divided fingertip patterns into 3 groups - Loops,

Arches and Whorls. Henry ER (1900)51, added 4th group ‘Composites’ to

demarcate more complex patterns. The composited form heterogeneous

group and include four chief types: 1) Central pocket loops 2) Lateral pocket

loops 3) Twin loops and 4) Accidental.

Penrose LS (1954)86 classified the fingertip ridge patterns into three

main types based on the presence of number of triradii. Thus, there is no

triradius in a arch, one in a loop and typically two triradii in a whorl. (Holt SB,

1961)55


Figure No 03: Showing Finger Tip Pattern Configuration


Finger Tip Pattern: (Figure No. 4)

a] ARCH (A): An arch is the simplest pattern. It consists of more or less

parallel ridges. The ridges curve the pattern area. The curve is proximally

concave. The curve is gentle in low arch and sharp in high arch.

1. Simple or Plain Arch (Ap): Ridges cross fingertip from one side to

the other without recurving. It is not a true pattern.

2. Tented Arch (At): In Tented Arch, ridges meet at a point. So their

smooth sweep is interrupted. The triradius is located near the

midline axis and distal phalynx.

The distal radiant of the triradius usually points towards the apex of the

fingertip. The ridges passing over this radiant are abruptly elevated and form

a tent like pattern.

Figure No 04: Showing different Finger Tip Patterns


Triradius: Triradius is the point of confluence of ridges. The ridges usually

radiate from this point in three different directions. (Penrose LS, 1965)88

b] LOOP (L): It is the most frequent pattern on fingertip. In this configuration

series of ridges enter and leave the pattern area on same side.

1. Ulnar Loop (Lu): In Ulnar Loop ridges opens on the ulnar side.

2. Radial Loop (Lr): In Radial Loop ridges open on the radial side.

Triradius: The triradius is located on the fingertip and on the same side

where the loop is crossed.

C] WHORLS (W): According to Galton’s classification, whorl is any ridge

configuration with two or more triradii. According to Henry’s classification

whorl is a ridge configuration in which ridges actually encircle core and more

complex patterns are called as ‘Composites’. Whorls are usually classified

into Simple/ Plain Whorls (Spiral or Concentric) and Double Loop Whorls

(Twin loop or Lateral pocket loop).

Types:

1. Concentric Whorl (Wc): The ridges are arranged as concentric rings

or ellipse (around the core).

2. Spiral Whorl (Ws): The ridges spiral around the core in clockwise or

anti-clockwise direction.

3. Mixed Whorl (Wmix): It contains circles and ellipse or spirals in the

same pattern.

4. Central Pocket Whorl (Wcp): It contains a smaller whorl within a loop.

It is sub-classified as ulnar or radial according to the side on which

outer loop opens.

5. Lateral Pocket Whorl (Wlp) or Twin Loop (Wtl): These types are

morphologically similar, have 2 triradii. In lateral pocket whorl both

ridges emanating from each core emerge on the same side of the

pattern. In twin loop whorl the ridges emanating from each core open

towards the opposite margin of the finger.


6. Accidentals (Wacc): Complex patterns, which cannot be classified as

one of the above patterns, are called accidentals. They represent a

combination of two or more configurations.

Dermatoglyphic Landmarks on the fingertip patterns

1. Triradii

2. Cores.

3. Radiants.

1. Triradius: A triradius is formed by confluence of three ridges systems.

Triradius Point: It is the geometric center of the triradius. Ideally it is the

meeting point of three ridges, if they fail to meet, the triradial point can

be represented by very short, dot like ridge called as island or by a

ridge ending or it may lie on a ridge at the point near the center of the

divergence of the three innermost ridges. Triradius in such cases is

described as extralimital and commonly observed in the hypothenar

area of the palm.

2. Core: It is approximate center of the palm. The core may be of different

shapes. In ridge counting the point of core (not the whole core) is used.

3. Radiants (type lines): Radiants are ridges that emanate from the

triradius and enclose the pattern area.

Quantitative Analysis:

Many Dermatoglyphic characteristics can be described quantitatively.

Pattern Intensity:

Pattern intensity refers to the complexity of ridge configuration. It can

be expressed by counting the number of triradii present. A digit may have

pattern intensity 0-3 according to the number of triradii. The simple arch which

lacks triradius is assigned number 0, whereas the tented arch and the loop

have intensity one.


Similarly, pattern intensity of the palm can be expressed as the sum of

all triradii present.

Ridge Counting: (Figure No. 5)

Ridge counting indicates the pattern size. It is primarily utilized in

fingertips as a way of expressing the distance between digital triradii to the

ridge density in a given area.

Figure No 05: Finger Ridge Counting in different Patterns

The counting is done along the straight lines connecting the core and

the triradius. Ridges containing triradial point and point of core are excluded.


In case of whorl with two triradii and at least one point of core, two different

counts are made, one from each triradii. Each count is made along a line

drawn between the triradial point and the nearer point of core. The two counts

are specified as first radial and second ulnar counts.

Usually the symbols and ridge counts are recorded in order, beginning

with the little finger of the left hand continuing to the thumb. While digits of

right hand are started with thumb and continued up to little finger. Because

the ridge counts are used to express the size, only the largest count is scored

in a pattern with more than one possible count. Both simple and tented arches

have ‘0’ count.

To some extent, ridge count reflects the pattern type (Holt SB,1961) 55.

Total Finger Ridge Count (TFRC):

TFRC represents the sum of ridge counts of all ten digits, where only

the larger count is used on those digits with more than one ridge count. It

expresses the size of pattern.

Absolute Finger Ridge Count (AFRC):

AFRC is the sum of the ridge counts from all the separate triradii on the

fingers. It reflects the pattern size as well as pattern intensity, which depends

on the pattern type.

PALMAR PATTERN CONFIGURATION: (Figure No. 6)

The palm has been divided into several anatomically well-divided areas

to carry out dermatoglyphic analysis. These areas approximate the sites of

embryonic volar pads. They include the thenar area, interdigital areas and

hypothenar area.

Hypothenar (Hypo): Hypothenar area is situated along the lower part of ulnar

border of hand and labelled as ‘Hypo’.


Thenar (Th): Thenar area is situated at the base of the thumb and labelled as

‘Th’.

First, Second, Third, Fourth Interdigital Areas (ID1, ID2, ID3, and ID4):

The first, second, third, fourth interdigital areas are found in the distal palm in

the region of heads of metacarpal bones. Each is bordered laterally by a

digital triradii. The digital triradii are located proximal to the base of digits II-V.

Digital Triradii are labelled as a, b, c, and d starting from digits II-V. The

interdigital area ID1 lie between ‘Th’ and ‘a’, ID2 between ‘a’ and ‘b’, ID3

between ‘b’ and ‘c’ and ID4 lies between ‘c’ and ‘d’.

If a (digital) triradius is absent, the midpoint of the base of the

corresponding digits can be used to separate interdigital areas.

Figure No 06: Showing Palmar Pattern Configuration and Palmar Areas

with Palmar Triradii


AXIAL TRIRADIUS (T):

The triradius or triradii close to palmar axis are termed as Axial triradius

(t). Symbol t, t’, t’’ are used to designate the position of these triradii in the

proximal distal direction on the palm. The axial triradii (t) are found in the

proximal region of palm, near the wrist crease.

t’’- triradius situated near the center of palm

t’- intermediate triradius situated between t’’ and t

Palmar Landmarks:

Digital and axial triradii are traced in the distal portion of the palm. They

are found in the metacarpal regions at the base of digits 2, 3, 4 and 5. They

are labelled as a, b, c and d from radial to ulnar direction. The two distal

radiant of each triradius run laterally to the nearest interdigital area (ID)

subtending the digit concerned.

Palmar Main Line:

The proximal radiant traced along its course within the palmar area

constitutes a palmar main line. There are four Main Lines each emanating

from one of the digital triradii and labelled as A, B, C, and D corresponding to

the triradius having the same lower case letter.

A triradius may be missing, two triradii may be fused into a single

triradius, or there may be additional (accessory) triradius/ triradii.

A missing triradius may be replaced by gently curving ridges and is

almost invariably limited to the area of triradius ‘c’. An accessory triradius/

triradii, when present are labelled according to the nearest digital triradii

(‘a’,’b’,’c’ or‘d’).

An interdigital triradius, a special case of missing triradius, lying in the

centre of an interdigital area is labelled in relation to the triradii it replace. E.g.,

‘bc’.


MAIN LINE FORMULA (MLF): (Figure No. 7)

The terminals of the main lines are assigned numbers distributed along

the periphery of the palm in order to convey information about their course.

Altogether 15 numbers are used. The numbering starts in the proximal

part of the thenar area and continues along the ulnar, distal and radial borders

of the palm. The termination of the main lines, recorded in the order D, C, B, A

are used to express the main line formula.

The main line formula constitutes the first part of the palmar formula. It

is followed by the position of the axial triradius/ triradii and then by symbols

used for the palmar configuration in the following order Hyp, Th, ID1, ID2, ID3,

and ID4.

Figure No 07: Showing numerical values used to designate termini of

Palmar Main Lines in Main Line Formula


TERMINI OF PALMAR MAIN LINES (PENROSE LS, 1968)89

Number Area or Point of Main Line Formula

1. Proximal radial border of the thenar area and interval between this

and t- triradius.

2. Triradius -t.

3. Interval between t and the midpoint of the ulnar border of the hand

from the distal wrist crease to the proximal crease of digit V.

4. Midpoint between the distal wrist crease and the proximal crease of

digit V on the ulnar border.

5’. Interval between midpoint of ulnar border and ulnar termination

of the distal transverse crease.

5’’ Interval between the ulnar termination of the distal transverse

crease and that of proximal crease of digit V.

6. Triradius -d.

7. Distal edge of interdigital area 4.

8. Triradius -c.

9. Distal edge of interdigital area 3

10. Triradius -b.

11. Distal edge of interdigital area 2.

12. Triradius -a.

13. Interval between distal edge of ID1 and radial termination of

radial longitudinal crease (thumb crease).

13’ Interval on radial border of the palm between the termination of

the radial longitudinal crease and the base of the thumb.

MAIN- LINE INDEX: (Figure No. 8)


The termini of two main lines, A and D alone adequately reflect the

ridge direction. A main line index is based on the sum of two numbers

corresponding to the exit of main lines A and D (Cummins H 1936)27. It is the

sum of terminations of A and D main lines, renumbering the terminations 1 to

5” as 1 to 6, and 6 to 13” as 1 to 9. (Reed T, 1981)104

The numerical values assigned to these exits are demonstrated in the

figure. The resulting value gives an estimate of palmar ridge transversally. A

low value for the index indicates vertical ridge alignment whereas high value

reflects a tendency for palmar ridge direction to be horizontal.

Figure No 08: Showing modified values of Main Line termination for

calculation of Main Line Index

ab RIDGE COUNT:


It is the number of ridges between triradii ‘a’ and ‘b’.

atd ANGLE:

atd angle is an indication of the degree of distal displacement of axial

triradius; and the angle increases as the triradius is more distally located. It

has been extensively used in dermatoglyphic examinations since it was

originally introduced by penrose in 1949. (Berg JM, 1968)11

It is formed by lines drawn from digital triradius ‘a’ to the axial triradius‘t’

and from axial triradius‘t’ to the digital triradius ‘d’. The more distal the position

of t, the larger the ‘atd’ angle. ‘atd’ angle is the most widely used method in

interpreting the position of triradius‘t’.

Though a valuable and rapid measurement, the atd angle has the

disadvantage of altering with age, because of the growth of the hand. It also

varies a little with the amount of pressure applied in producing a palm print.

(Berg JM, 1968)11


STATISTICAL ANALYSIS:

The following statistical tests are chosen for the research project:

1) Arithmetic Mean (X): It is most commonly used measure of central

tendency. It is a simple expression showing the net result of a series or

group.

a. Formula: X= xi n

Where X= Mean

xi= ith observation

n= total number of observation

b. For grouped data: X= fixi fi

Where: xi= mid value of ith class interval

fi = frequency of ith class interval

2. Standard Deviation (SD): It is the most frequently used measure of

deviation. In simple terms, it is defined as “Root- Means- Square-Deviation”.

For n> 30

a. For Ungrouped data: SD= (x-X)2

nWhere X= Mean

n= total number of observation

b. For Grouped data: SD= fd2

nWhere d=deviation of items in series from mean

f=frequency of a particular class interval

3. Standard Error of Mean (SE): It is a measure which enables us to judge

whether the mean of a given sample is within the set of confidence limits or

not.

SE= SD n


4. Coefficient of variation (C.V): It helps us in finding which of the given

groups is more stable or show less variations.

CV=SD x 100 n

5. ‘t’ test of significance: It is used to test significance of the difference

between two sample means.

Formula: |X1-X2|

t = (S.D)12 (S.D) 2

2

n1 n2 and df – degree of freedom = ( n 1+n2 ) – 2

where, X1, (S.D) 1 & n1 – are mean, S.D & no. of items in 1st group

X2, (S.D) 2 & n2 – are mean, S.D & no. of items in 2nd group

6. X2 – Chi Square test of significance:

Formula : X 2 = ( Oi-Ei) 2

Ei

And df = (r-1) (c-1)

Ei = ith expected frequency

r = number of rows

c = number of columns

r x c = size of contingency table

7. Furuhata’s Index:

Formula: Furuhata’s Index = Whorls x 100 Loops

8. Dankmejer’s Index:

Formula: Dankmejer’s Index = Arches x 100 Whorls


Figure Showing Coronary Angiography in Single Vessel Disease and Triple Vessel Disease

Figure Showing Coronary Angiography in Coronary Artery Disease


Figure showing Palmar Print of Right Hand of Male Control


Figure showing Palmar Print of Left Hand of Male Control


Figure showing Palmar Print of Right Hand of Female Control


Figure showing Palmar Print of Left Hand of Female Control


Figure showing Palmar Print of Right Hand of Male CAD Patient


Figure showing Palmar Print of Left Hand of Male CAD Patient


Figure showing Palmar Print of Right Hand of Female CAD Patient


Figure showing Palmar Print of Left Hand of Female CAD Patient


LIST OF TABLES

Table 01 : Age and sex wise distribution in cases and controls.

Table 02 : Distribution of Different Groups depending on the number of vessels involved in CAD cases

Table 03 : Percentage wise distribution of total Finger Tip patterns in CAD and Controls

Table 04 : Frequency distribution of Loop Patterns on Finger Tips in CAD and Controls

Table 05 : Frequency distribution of Arch Patterns on Finger Tips in CAD and Controls

Table 06 : Frequency distribution of Whorls Patterns on Finger Tips in CAD and Controls

Table 07 : Digit wise frequency distribution of Fingertip Patterns of both hands in SVD cases (M=41,F=12, T=53 cases)

Table 08 : Digit wise frequency distribution of Fingertip Patterns of both hands in DVD cases (M=34,F=7, T=41 cases)

Table 09 : Digit wise frequency distribution of Fingertip Patterns of both hands in TVD cases (M=45,F=11, T=56 cases)

Table 10 : Frequency distribution of total Fingertip Patterns in different groups of CAD and Controls

Table 11 : Statistical Comparison of Total Finger Tip Pattern between different groups of CAD with Controls.

Table 12 (a) : Digit wise frequency distribution of Finger Tip Patterns in CAD and Controls in Males and Females

Table 12 (b) : Digit wise frequency distribution of Finger Tip Patterns in CAD and Controls in both hands

Table 13 : Frequency distribution of Different Finger Tip Patterns in total CAD and Controls

Table 14 (a) : Statistical Comparison of different Finger Tip Pattern between CAD and Controls in Males and Females.

Table 14 (b) : Statistical Comparison of different Finger Tip Pattern between CAD and Controls in both hands.

Table 15 : Frequency distribution of Total Finger Ridge Count (TFRC) in Different Groups of CAD

Table 16 : Statistical Calculation of TFRC count in different Groups of CAD and Controls

Table 17 : Test of Significance for TFRC for comparison between different Groups of CAD and Controls


Table 18 : Frequency distribution of Total Finger Ridge Count (TFRC) in total CAD and Controls

Table 19 : Statistical Calculation for TFRC in total CAD and Controls

Table 20 : Test of Significance for TFRC for comparison between total CAD and Controls

Table 21 : Frequency distribution of Absolute Finger Ridge Count (AFRC) in Different Groups of CAD

Table 22 : Statistical Calculation of AFRC count in different Groups of CAD and Controls

Table 23 : Test of Significance for AFRC for comparison between different Groups of CAD and Controls

Table 24 : Frequency distribution of Absolute Finger Ridge Count (AFRC) in total CAD and Controls

Table 25 : Statistical Calculation for AFRC in total CAD and Controls

Table 26 : Test of Significance for AFRC for comparison between total CAD and Controls

Table 27 : Frequency Distribution of True Palmar Patterns in Different Groups of CAD and Controls

Table 28 : Statistical Comparison of true Palmar Pattern between different groups of CAD with Controls.

Table 29 : Frequency Distribution of True Palmar Patterns in total CAD and Controls

Table 30 (a) : Statistical Comparison of true Palmar Pattern between CAD and Controls in Males and Females.

Table 30 (b) : Statistical Comparison of true Palmar Pattern between CAD and Controls in both hands

Table 31 : Frequency Distribution of Position of Axial Triradii in Different Groups of CAD

Table 32 : Statistical Comparison of Position of Axial Triradii between different groups of CAD with Controls.

Table 33 : Frequency Distribution of Position of Axial Triradii in total CAD and Controls

Table 34 (a) : Statistical Comparison of Position of Axial Triradii between CAD and Controls in Males and Females.

Table 34 (b) : Statistical Comparison of Position of Axial Triradii between CAD and Controls in both hands.

Table 35 : Frequency Distribution of Number of Palmar Triradii in Different Groups of CAD

Table 36 : Statistical Comparison of Number of Palmar Triradii between different groups of CAD with Controls.

Table 37 : Frequency Distribution of Number of Palmar Triradii in total CAD and Controls


Table 38 (a) : Statistical Comparison of Number of Palmar Triradii between CAD and Controls in Males and Females.

Table 38 (b) : Statistical Comparison of Number of Palmar Triradii between CAD and Controls in both hands.

Table 39 : Statistical Calculation of ab Ridge count in different Groups of CAD and Controls

Table 40 : Test of Significance for ab Ridge count for comparison between different Groups of CAD and Controls

Table 41 : Frequency distribution of ab Ridge count in total CAD and Controls

Table 42 : Statistical Calculation for a-b Ridge Count in total CAD and Controls

Table 43 : Test of Significance for a-b Ridge Count for comparison between total CAD and Control

Table 44 : Statistical Calculation of atd angle in different Groups of CAD and Controls

Table 45 : Test of Significance for atd angle for comparison between different Groups of CAD and Controls

Table 46 : Frequency distribution of atd angle in total CAD and Controls

Table 47 : Statistical Calculation for atd angle in total CAD and Controls

Table 48 : Test of Significance for atd angle for comparison between total CAD and Controls


ABBREVIATIONS USED IN TABLESM : Male

F : Female

M+F : Male + Female

T : Total

R : Right

L : Left

R+L : Right + Left

No. : Number

% : Percentage

N : Normal subject (i.e. Controls)

C : CAD subject/ patients (i.e. Case)

NMR : Normal Male Right

CMR : Case Male Right

NFR : Normal Female Right

CFR : Case Female Right

NTR : Normal Total Right (Total =M+F)

CTR : Case Total Right (Total =M+F)

FH Index : Furuhata’s Index

DM Index : Dankmejer’s Index

FTP : Finger Tip Pattern

L : Loop

A : Arches

W : Whorls

CAD : Coronary Artery Disease

SVD : Single Vessel Disease

DVD : Double Vessel Disease

TVD : Triple/ Multi Vessel Disease

Ws : Whorl Spiral

Wc : Whorl Concentric

Wtl : Twin Loop Whorl

Wlp : Lateral Pocket Whorl

Wcp : Central Pocket Whorl

TFRC : Total Finger Ridge Count


AFRC : Absolute Finger Ridge Count

X2 or Chi Sq : Chi Square

NS : Not Significant

S : Significant

D1 : First Digit/ Thumb

D2 : Second Digit/ Index Finger

D3 : Third Digit/ Middle Finger

D4 : Fourth Digit/ Ring Finger

D5 : Fifth Digit/ Little Finger

CI : Class Interval

X : Mean

SD : Standard Deviation

SE-M : Standard Error of Mean

CV : Coefficient of Variation in %,

Hypo : Hypothenar

Th : Thenar

ID1 : First Inter-digital area

ID2 : Second Inter-digital area

ID3 : Third Inter-digital area

ID4 : Fourth Inter-digital area

t = Triradius near wrist crease

t" = Triradius near centre of palm

t' = Triradius between t and t"

t t' = Two Triradii one t and another t'

tt" = Two Triradii one t' and another t"

DDA = Distal Displacement of Axial Triradii.


RESULTS:

The dermatoglyphic patterns on right and left hand of CAD patients are

analysed according to sex and are subjected to statistical tests to evaluate

significant pattern of identifiable difference between CAD and Controls.

The dermatoglyphic patterns are analysed under following heading:

I. Qualitative analysis of Finger Prints

a. Loops

b. Arches

c. Whorls

II. Quantitative analysis of Finger Print

a. Total Finger Ridge Count (TFRC)

b. Absolute Finger Ridge Count (AFRC)

III. Qualitative analysis of Palmar patterns in different palmar areas

IV. Position of Axial Triradii (t, t’, t”)

V. Total Number of Palmar Triradii

VI. a b Ridge Count

VII. atd Angle

Table 1: Age and sex wise distribution in cases and controls.

Age CAD (Cases) CONTROL Group Male Female Total Male Female Total in yrs No % No % No % No % No % No %31-40 8 6.7 1 3.3 9 6.0 56 46.7 14 46.7 70 46.741-50 34 28.3 12 40.0 46 30.7 55 45.8 9 30.0 64 42.751-60 42 35.0 11 36.7 53 35.3 8 6.7 6 20.0 14 9.361-70 28 23.3 6 20.0 34 22.7 0 0.0 1 3.3 1 0.771 & > 8 6.7 0 0.0 8 5.3 1 0.8 0 0.0 1 0.7Total 120 80.0 30 20.0 150 100.0 120 80.0 30 20.0 150 100.0

Table 1: shows age and sex distribution among cases and controls. In the

present study, 150 cases of angiographically proven CAD and 150 healthy

individual (controls) were included for comparison of various parameters.


There were 120 males and 30 females in each group. The age ranges from

35-76 years with mean age of male and female is 55.18 years and 53.83

years respectively in CAD. The age ranges from 31-75 years with mean age

of male and female is 41.29 years and 43 years respectively in controls.

Table 2: Distribution of Different Groups depending on the number of vessels

involved in CAD cases

No of vessels Male Female Total

involved No % No % No %

SVD 41 34.2 12 40.0 53 35.3

DVD 34 28.3 7 23.3 41 27.3

TVD 45 37.5 11 36.7 56 37.3

TOTAL 120 80.0 30 20.0 150 100.0

Table 2: shows distribution of number of vessels involved in CAD due to

atherosclerotic lesion. 35.3% of the patients have single vessel involvement

(SVD), 27.3% of cases have double vessels involvement (DVD), and 37.3%

have three vessels involvement (TVD).

I. QUALITATIVE ANALYSIS OF FINGER PATTERNS: FINGER TIP

PATTERNS

Qualitative analysis of Finger Tips is done according to Galton’s (1892)39

Classification. Henry ER (1900)51 added ‘Composite’ as 4th group to

demarcate more complex patterns and it includes Central Pocket Loop,

Lateral Pocket Loop, Twin Loop, and Accidental Whorls.


Table 3: Percentage wise distribution of total Finger Tip patterns in CAD and

Controls

Subject SEX Side Total % Total % Total % FH DM LOOPS ARCHES WHORLS Index IndexCAD M R 296 49.3 38 6.3 266 44.3 89.86 14.3

L 312 52.0 37 6.2 251 41.8 80.45 14.7 R+L 608 50.7 75 6.3 517 43.1 85.03 14.5 F R 89 59.3 13 8.7 48 32.0 53.93 27.1 L 82 54.7 14 9.3 54 36.0 65.85 25.9 R+L 171 57.0 27 9.0 102 34.0 59.65 26.5 M+F R 385 51.3 51 6.8 314 41.9 81.56 16.2 L 394 52.5 51 6.8 305 40.7 77.41 16.7 R+L 779 51.9 102 6.8 619 41.3 79.46 16.5Controls M R 325 54.2 50 8.3 225 37.5 69.23 22.2 L 360 60.0 44 7.3 196 32.7 54.44 22.4 R+L 685 57.1 94 7.8 421 35.1 61.46 22.3 F R 96 64.0 16 10.7 38 25.3 39.58 42.1 L 89 59.3 14 9.3 47 31.3 52.81 29.8 R+L 185 61.7 30 10.0 85 28.3 45.95 35.3 M+F R 421 56.1 66 8.8 263 35.1 62.47 25.1 L 449 59.9 58 7.7 243 32.4 54.12 23.9 R+L 870 58.0 124 8.3 506 33.7 58.16 24.5

Table 3 shows percentage wise distribution of Finger Tip Patterns in total

CAD and controls.

The percentage of loops is 50.7% and 57% in CAD males and CAD

females as compared to 57.1% and 61.7% in control males and control

females respectively.

The percentage of arches is 6.3% and 9% in CAD males and CAD

females as compared to 7.8% and 10% in control males and control females

respectively.

The percentage of whorls is 43.1% and 34% in CAD males and CAD

females as compared to 35.1% and 28.3% in control males and control

females respectively.

The percentage of loop, arch and whorls is 51.9%, 6.8% and 41.3%

respectively in CAD (M+F) as compared to 58%, 8.3% and 33.7% respectively

in control (M+F).


Thus, there is decrease in the percentage of loops/ arches in both

sexes with corresponding increase in the percentage of whorls patterns in

CAD as compared to the controls.

Furuhata’s Index is 85.03 in CAD males and 61.46 in control males,

whereas it is 59.65 in CAD females and 45.95 in control females. The

Furuhata’s Index is 79.46 in CAD (M+F) and 58.16 in control (M+F).

The Dankmejer’s Index is 14.5 in CAD males and 22.2 in control

males, whereas it is 26.5 in CAD females and 35.3 in control females. The

Index is 16.5 in CAD (M+F) and 24.5 in control (M+F).

Table 4: Frequency distribution of Loop Patterns on Finger Tips in CAD and

Controls

Subject S Side ULNAR RADIAL TOTAL E LOOPS LOOPS LOOPS X No % No % No %CAD M R 287 47.8 9 1.5 296 49.3 L 303 50.5 9 1.5 312 52.0 R+L 590 49.2 18 1.5 608 50.7 F R 86 57.3 3 2.0 89 59.3 L 82 54.7 3 2.0 85 56.7 R+L 171 56.0 6 2.0 177 58.0 M+F R 373 49.7 12 1.6 385 51.3 L 382 50.9 12 1.6 394 52.5 R+L 755 50.3 24 1.6 779 51.9Controls M R 315 52.5 10 1.7 325 54.2 L 352 58.7 8 1.3 360 60.0 R+L 667 55.6 18 1.5 685 57.1 F R 94 62.7 2 1.3 96 64.0 L 81 54.0 8 5.3 89 59.3 R+L 175 58.3 10 3.3 185 61.7 M+F R 409 54.5 12 1.6 421 56.1 L 433 57.7 16 2.1 449 59.9 R+L 842 56.1 28 1.9 870 58.0

Table 4 shows frequency distribution of loop patterns in CAD and controls.

There is a predominance of ulnar loop patterns as compared to radial loop

pattern in both sexes in CAD as well as in the controls. The total percentage

of ulnar loop is 50.3% and radial loop is 1.6% in CAD whereas it is 56.1% and

1.9% respectively in controls.


Table 5: Frequency distribution of Arch Patterns on Finger Tips in CAD

and Controls

Subject S Side PLAIN TENTED TOTAL E ARCHES ARCHES ARCHES X No % No % No %CAD M R 17 2.8 21 3.5 38 6.3 L 11 1.8 26 4.3 37 6.2 R+L 28 2.3 47 3.9 75 6.3 F R 5 3.3 8 5.3 13 8.7 L 3 2.0 11 7.3 14 9.3 R+L 8 2.7 19 6.3 27 9.0 M+F R 22 2.9 29 3.9 51 6.8 L 14 1.9 37 4.9 51 6.8 R+L 36 2.4 66 4.4 102 6.8Controls M R 11 1.8 39 6.5 50 8.3 L 15 2.5 29 4.8 44 7.3 R+L 26 2.2 68 5.7 94 7.8 F R 7 4.7 9 6.0 16 10.7 L 8 5.3 6 4.0 14 9.3 R+L 15 5.0 15 5.0 30 10.0 M+F R 18 2.4 48 6.4 66 8.8 L 23 3.1 35 4.7 58 7.7 R+L 41 2.7 83 5.5 124 8.3

Table 5 shows frequency distribution of arch patterns in CAD and controls.

There is increase in the percentage of tented arch as compared to the plain

arch in both sexes of CAD as well as in control males. In control females, the

percentage of both tented and plain arches is same. The total percentage of

tented arch is 4.4% and plain arch is 2.4% in CAD whereas it is 5.5% and

2.7% respectively in controls.

Table 6:Frequency distribution of Whorls Patterns on Finger Tips in CAD

and Controls


Subject S Side Simple Whorls Double Loop Whorls Other TOTAL

E Ws Wc Total Wtl Wlp Total Wcp+ WHORLS

X No % No % No % No % No % No % No % No %

CAD M R 124 20.7 67 11.2 191 31.8 14 2.3 18 3.0 32 5.3 43 7.2 266 44.3

L 113 18.8 49 8.2 162 27.0 34 5.7 15 2.5 49 8.2 40 6.7 251 41.8

R+L 237 19.8 116 9.7 353 29.4 48 4.0 33 2.8 81 6.8 83 6.9 517 43.1

F R 26 17.3 8 5.3 34 22.7 1 0.7 4 2.7 5 3.3 9 6.0 48 32.0

L 28 18.7 15 10.0 43 28.7 4 2.7 3 2.0 7 4.7 4 2.7 54 36.0

R+L 54 18.0 23 7.7 77 25.7 5 1.7 7 2.3 12 4.0 13 4.3 102 34.0

M+F R 150 20.0 75 10.0 225 30.0 15 2.0 22 2.9 37 4.9 52 6.9 314 41.9

L 141 18.8 64 8.5 205 27.3 38 5.1 18 2.4 56 7.5 44 5.9 305 40.7

R+L 291 19.4 139 9.3 430 28.7 53 3.5 40 2.7 93 6.2 96 6.4 619 41.3Controls M R 102 17.0 75 12.5 177 29.5 16 2.7 16 2.7 32 5.3 16 2.7 225 37.5

L 93 15.5 42 7.0 135 22.5 23 3.8 12 2.0 35 5.8 26 4.3 196 32.7

R+L 195 16.3 117 9.8 312 26.0 39 3.3 28 2.3 67 5.6 42 3.5 421 35.1

F R 17 11.3 8 5.3 25 16.7 1 0.7 2 1.3 3 2.0 10 6.7 38 25.3

L 24 16.0 11 7.3 35 23.3 3 2.0 4 2.7 7 4.7 5 3.3 47 31.3

R+L 41 13.7 19 6.3 60 20.0 4 1.3 6 2.0 10 3.3 15 5.0 85 28.3

M+F R 119 15.9 83 11.1 202 26.9 17 2.3 18 2.4 35 4.7 26 3.5 263 35.1

L 117 15.6 53 7.1 170 22.7 26 3.5 16 2.1 42 5.6 31 4.1 243 32.4

R+L 236 15.7 136 9.1 372 24.8 43 2.9 34 2.3 77 5.1 57 3.8 506 33.7

Table 6 shows frequency distribution of whorl pattern in CAD and controls.

Simple whorls (whorls spiral and whorls concentric) are predominantly seen

as compared to double loop whorls (twin loop and lateral pocket loop) and

other composite whorls in both sexes in CAD as well as controls. In CAD,

whorls spiral is seen in 19.4%, whorls concentric in 9.3%, double loop whorls

in 6.2% and other in 6.4%. While in controls, whorls spiral is seen in 15.7%,

whorls concentric in 9.1%, double loop whorls in 5.1% and other in 3.8%.

Table 7 to 9 shows digit wise frequency distribution of Finger Tip Patterns of

both hands in different groups of CAD.

Table 7: Digit wise frequency distribution of Fingertip Patterns of both hands in

SVD cases (M=41,F=12, T=53 cases)

Digit Side LOOPS ARCHES WHORLS TOTAL TOTAL TOTAL


Male Female Male Female Male Female LOOPS ARCHES WHORLS No % No % No % No % No % No % No % No % No %D1 R 17 41.5 8 66.7 1 2.4 0 0.0 23 56.1 4 33.3 25 47.2 1 1.9 27 50.9 L 19 46.3 6 50.0 3 7.3 0 0.0 19 46.3 6 50.0 25 47.2 3 5.7 25 47.2 R+L 36 43.9 14 58.3 4 4.9 0 0.0 42 51.2 10 41.7 50 47.2 4 3.8 52 49.1D2 R 15 36.6 5 41.7 6 14.6 2 16.7 20 48.8 5 41.7 20 37.7 8 15.1 25 47.2 L 13 31.7 7 58.3 9 22.0 2 16.7 19 46.3 3 25.0 20 37.7 11 20.8 22 41.5 R+L 28 34.1 12 50.0 15 18.3 4 16.7 39 47.6 8 33.3 40 37.7 19 17.9 47 44.3D3 R 25 61.0 8 66.7 3 7.3 2 16.7 13 31.7 2 16.7 33 62.3 5 9.4 15 28.3 L 24 58.5 7 58.3 2 4.9 3 25.0 15 36.6 2 16.7 31 58.5 5 9.4 17 32.1 R+L 49 59.8 15 62.5 5 6.1 5 20.8 28 34.1 4 16.7 64 60.4 10 9.4 32 30.2D4 R 11 26.8 4 33.3 0 0.0 3 25.0 30 73.2 5 41.7 15 28.3 3 5.7 35 66.0 L 12 29.3 6 50.0 2 4.9 2 16.7 27 65.9 4 33.3 18 34.0 4 7.5 31 58.5 R+L 23 28.0 10 41.7 2 2.4 5 20.8 57 69.5 9 37.5 33 31.1 7 6.6 66 62.3D5 R 23 56.1 8 66.7 1 2.4 2 16.7 17 41.5 2 16.7 31 58.5 3 5.7 19 35.8 L 29 70.7 10 83.3 0 0.0 1 8.3 12 29.3 1 8.3 39 73.6 1 1.9 13 24.5 R+L 52 63.4 18 75.0 1 1.2 3 12.5 29 35.4 3 12.5 70 66.0 4 3.8 32 30.2

Table 8: Digit wise frequency distribution of Fingertip Patterns of both hands in

DVD cases (M=34,F=7, T=41 cases)

Digit Side LOOPS ARCHES WHORLS TOTAL TOTAL TOTAL Male Female Male Female Male Female LOOPS ARCHES WHORLS No % No % No % No % No % No % No % No % No %D1 R 16 47.1 6 85.7 2 5.9 0 0.0 16 47.1 1 14.3 22 53.7 2 4.9 17 41.5 L 13 38.2 7 100.0 2 5.9 0 0.0 19 55.9 0 0.0 20 48.8 2 4.9 19 46.3 R+L 29 42.6 13 92.9 4 5.9 0 0.0 35 51.5 1 7.1 42 51.2 4 4.9 36 43.9D2 R 13 38.2 5 71.4 6 17.6 1 14.3 15 44.1 1 14.3 18 43.9 7 17.1 16 39.0 L 16 47.1 5 71.4 5 14.7 1 14.3 13 38.2 1 14.3 21 51.2 6 14.6 14 34.1 R+L 29 42.6 10 71.4 11 16.2 2 14.3 28 41.2 2 14.3 39 47.6 13 15.9 30 36.6D3 R 24 70.6 7 100.0 2 5.9 0 0.0 8 23.5 0 0.0 31 75.6 2 4.9 8 19.5 L 23 67.6 5 71.4 4 11.8 0 0.0 7 20.6 2 28.6 28 68.3 4 9.8 9 22.0 R+L 47 69.1 12 85.7 6 8.8 0 0.0 15 22.1 2 14.3 59 72.0 6 7.3 17 20.7D4 R 13 38.2 2 28.6 1 2.9 0 0.0 20 58.8 5 71.4 15 36.6 1 2.4 25 61.0 L 22 64.7 3 42.9 0 0.0 0 0.0 12 35.3 4 57.1 25 61.0 0 0.0 16 39.0 R+L 35 51.5 5 35.7 1 1.5 0 0.0 32 47.1 9 64.3 40 48.8 1 1.2 41 50.0D5 R 29 85.3 4 57.1 0 0.0 0 0.0 5 14.7 3 42.9 33 80.5 0 0.0 8 19.5 L 25 73.5 5 71.4 0 0.0 0 0.0 9 26.5 2 28.6 30 73.2 0 0.0 11 26.8 R+L 54 79.4 9 64.3 0 0.0 0 0.0 14 20.6 5 35.7 63 76.8 0 0.0 19 23.2Table 9: Digit wise frequency distribution of Fingertip Patterns of both hands in

TVD cases (M=45,F=11, T=56 cases)

Digit Side LOOPS ARCHES WHORLS TOTAL TOTAL TOTAL Male Female Male Female Male Female LOOPS ARCHES WHORLS No % No % No % No % No % No % No % No % No %D1 R 18 40.0 4 36.4 2 4.4 0 0.0 25 55.6 7 63.6 22 39.3 2 3.6 32 57.1 L 20 44.4 1 9.1 2 4.4 0 0.0 23 51.1 10 90.9 21 37.5 2 3.6 33 58.9 R+L 38 42.2 5 22.7 4 4.4 0 0.0 48 53.3 17 77.3 43 38.4 4 3.6 65 58.0


D2 R 18 40.0 5 45.5 8 17.8 0 0.0 19 42.2 6 54.5 23 41.1 8 14.3 25 44.6 L 22 48.9 2 18.2 3 6.7 2 18.2 20 44.4 7 63.6 24 42.9 5 8.9 27 48.2 R+L 40 44.4 7 31.8 11 12.2 2 9.1 39 43.3 13 59.1 47 42.0 13 11.6 52 46.4D3 R 30 66.7 8 72.7 5 11.1 2 18.2 10 22.2 1 9.1 38 67.9 7 12.5 11 19.6 L 28 62.2 6 54.5 4 8.9 2 18.2 13 28.9 3 27.3 34 60.7 6 10.7 16 28.6 R+L 58 64.4 14 63.6 9 10.0 4 18.2 23 25.6 4 18.2 72 64.3 13 11.6 27 24.1D4 R 12 26.7 5 45.5 1 2.2 1 9.1 32 71.1 5 45.5 17 30.4 2 3.6 37 66.1 L 15 33.3 3 27.3 1 2.2 0 0.0 29 64.4 8 72.7 18 32.1 1 1.8 37 66.1 R+L 27 30.0 8 36.4 2 2.2 1 4.5 61 67.8 13 59.1 35 31.3 3 2.7 74 66.1D5 R 32 71.1 10 90.9 0 0.0 0 0.0 13 28.9 1 9.1 42 75.0 0 0.0 14 25.0 L 31 68.9 9 81.8 0 0.0 1 9.1 14 31.1 1 9.1 40 71.4 1 1.8 15 26.8 R+L 63 70.0 19 86.4 0 0.0 1 4.5 27 30.0 2 9.1 82 73.2 1 0.9 29 25.9

Table 7 shows increase frequency of loops in D3 and D5 and whorls in D1,

D2 and D4 in cases of SVD. The maximum percentage of loops is 73.6% in

D5 of left hand and 62.3% in D3 of right hand. The maximum percentage of

whorls is 66% in D4 of right hand and 50.9% in D1 of right hand. Most

numbers of arches are seen in D2 of both hands.

Table 8 shows increase frequency of whorls in D4 and loops in rest of the digit

in cases of DVD. The maximum percentage of whorls is seen in D4 of right

hand (61%) and D1 of left hand (46.3%). The maximum percentage of loops

is 80.5% in D5 of right hand and 75.6% in D3 of right hand. Most numbers of

arches are seen in D2 of both hands.

Table 9 shows increase frequency of loop in D3 and D5 and whorls in D1, D2

and D4 in cases of TVD. The maximum percentage of loops is 73.3% in D5 of

left hand and 66.7% in D5 of right hand. The maximum percentage of whorls

is 68.9% and 60% in D4 of right and left hand respectively. Most numbers of

arches are seen in D2 of both hands.

Table 10: Frequency distribution of total Fingertip Patterns in different groups

of CAD and Controls

Groups Side LOOPS ARCHES WHORLS TOTAL TOTAL TOTAL

of Male Female Male Female Male Female LOOPS ARCHES WHORLS

CAD No % No % No % No % No % No % No % No % No %

SVD R 91 44.4 33 55.0 11 5.4 9 15.0 103 50.2 18 30.0 124 46.8 20 7.5 121 45.7

m=41 L 97 47.3 36 60.0 16 7.8 8 13.3 92 44.9 16 26.7 133 50.2 24 9.1 108 40.8

f=12 R+L 188 45.9 69 57.5 27 6.6 17 14.2 195 47.6 34 28.3 257 48.5 44 8.3 229 43.2


t=53

DVD R 95 55.9 24 68.6 11 6.5 1 2.9 64 37.6 10 28.6 119 58.0 12 5.9 74 36.1

m=34 L 99 58.2 25 71.4 11 6.5 1 2.9 60 35.3 9 25.7 124 60.5 12 5.9 69 33.7

f=7 R+L 194 57.1 49 70.0 22 6.5 2 2.9 124 36.5 19 27.1 243 59.3 24 5.9 143 34.9

t=41

TVD R 110 48.9 32 58.2 16 7.1 3 5.5 99 44.0 20 36.4 142 50.7 19 6.8 119 42.5

m=45 L 116 51.6 21 38.2 10 4.4 5 9.1 99 44.0 29 52.7 137 48.9 15 5.4 128 45.7

f=11 R+L 226 50.2 53 48.2 26 5.8 8 7.3 198 44.0 49 44.5 279 49.8 34 6.1 247 44.1

t=56 Controls R 325 54.2 96 64.0 50 8.3 16 10.7 225 37.5 38 25.3 421 56.1 66 8.8 263 35.1

m=120 L 360 60.0 89 59.3 44 7.3 14 9.3 196 32.7 47 31.3 449 59.9 58 7.7 243 32.4

f=30 R+L 685 57.1 185 61.7 94 7.8 30 10.0 421 35.1 85 28.3 870 58.0 124 8.3 506 33.7

t=150

Table 11: Statistical Comparison of Total Finger Tip Pattern between different

groups of CAD with Controls.

Groups of FINGER TIP PATTERNS CAD LOOPS ARCHES WHORLSCONTROLS 870 124 506% 58.0 8.3 33.7SVD 257 44 229% 48.5 8.3 43.2Chi Sq 13.96 0.00 14.81P-Value 0.0001869 0.9470546 0.0001188Remark S NS SDVD 243 24 143% 59.3 5.9 34.9Chi Sq 0.16 2.30 0.14P-Value 0.6854632 0.1297030 0.7077705Remark NS NS NSTVD 279 34 247% 49.8 6.1 44.1Chi Sq 10.73 2.47 18.48P-Value 0.0010549 0.1157774 0.0000172Remark S NS S

Table 10 shows frequency distribution of Finger Tip Patterns in different

groups of CAD and controls. Table 11 shows statistical comparison of FTP

between different groups of CAD with controls. The maximum percentage of

loops is seen in DVD in both sexes. Most numbers of arches are seen in SVD

in both sexes. The maximum percentage of whorls is seen in TVD (female)

and SVD (male).

In SVD, there is decrease in the percentage of loop pattern and

increase in whorl patterns as compared to the controls with statistically


significant difference is seen in loop pattern (P<0.001) and whorl pattern

(P<0.001) when compared with controls.

In DVD, there is slight increase in the percentage of loop and whorl

pattern and decrease in arch pattern as compared to the controls but no

statistically significant difference in any finger tip pattern.

In TVD, there is decrease in the percentage of loop/ arch pattern and

increase in whorl patterns as compared to the controls with statistically

significant difference is seen in loop pattern (P<0.01) and whorl pattern

(P<0.0001) when compared with controls.

Table 12 (a) shows digit wise frequency distribution of Finger Tip Patterns in

CAD and controls in Males and Females.

The frequency of loops decreases in all digits of CAD in both sexes

with statistically significant difference is seen in D1 in males (P<0.05); and no

statistically significant difference is seen in any digit in females when

compared with the controls.

The frequency of arches usually decreases in all digits of CAD in both

sexes, expect D1 in males; and D4 and D5 in females with statistically

significant difference is seen in D5 in males (P<0.01); and D1 (P<0.01) & D5

(P<0.05) in females when compared with controls.

The frequency of whorls increases in all digit of CAD in both sexes,

except D4 in females with statistically significant difference is seen in D5 in

males (P<0.01); and no statistical significant difference in any digit of females

when compared with controls.

Table 12 (a): Digit wise frequency distribution of Finger Tip Patterns in CAD

and Controls in Males and Females

FTP Subject MALES (120+120) FEMALES (30+30) I II III IV V I II III IV VL CAD 103 97 154 85 169 32 29 41 23 46 Con 130 107 166 96 186 33 36 42 23 51 X2 5.64 0.69 1.13 0.89 2.77 0.03 1.21 0.04 0.04 0.86 P Value 0.018 0.406 0.287 0.346 0.096 0.855 0.272 0.843 0.851 0.354 Remark S NS NS NS NS NS NS NS NS NSA CAD 12 37 20 5 1 0 8 9 6 4


Con 6 45 21 10 12 7 10 9 4 0 X2 1.44 0.72 0.03 1.10 7.91 5.46 0.07 0.07 0.11 4.14 P Value 0.230 0.396 0.870 0.294 0.005 0.006 0.798 0.798 0.741 0.042 Remark NS NS NS NS S S NS NS NS SW CAD 125 106 66 150 70 28 23 10 31 10 Con 104 88 53 134 42 20 14 9 33 9 X2 3.68 2.50 1.61 1.94 8.49 1.70 2.50 0.06 0.03 0.06 P Value 0.055 0.114 0.205 0.164 0.004 0.192 0.114 0.803 0.855 0.803 Remark NS NS NS NS S NS NS NS NS NS

Table 12 (b): Digit wise frequency distribution of Finger Tip Patterns in CAD

and Controls in both hands

FTP Subject RIGHT HAND DIGITS LEFT HAND DIGITS I II III IV V I II III IV VL CAD 69 61 102 47 106 66 65 93 61 109 Con 80 65 104 58 114 83 78 104 61 123 X2 1.33 0.12 0.02 1.47 0.84 3.85 1.92 1.48 0.01 3.21 P Value 0.248 0.726 0.901 0.226 0.361 0.050 0.165 0.224 0.906 0.073 Remark NS NS NS NS NS ~S NS NS NS NSA CAD 5 23 12 6 5 7 22 15 5 2 Con 5 30 16 8 7 8 25 14 6 5 X2 0.10 0.82 0.35 0.07 0.09 0.07 0.10 0.04 0.09 0.59 P Value 0.748 0.364 0.552 0.784 0.768 0.791 0.751 0.845 0.759 0.448 Remark NS NS NS NS NS NS NS NS NS NSW CAD 76 66 32 97 43 77 63 42 84 39 Con 65 55 30 84 29 59 47 32 83 22 X2 1.34 1.39 0.02 2.01 3.58 3.89 3.67 1.45 0.01 5.27 P Value 0.247 0.239 0.887 0.157 0.059 0.049 0.055 0.228 0.907 0.022 Remark NS NS NS NS NS S NS NS NS S

Table 12 (b) shows digit wise frequency distribution of Finger Tip Patterns in

right and left hand. There is decrease frequency of loop patterns in all digits of

CAD with corresponding increase of whorl patterns in both hand with

statistically significant difference in whorl pattern in D1 and D5 of left hand

(P<0.05) and comparable in loop pattern in D1 of left hand (P=0.05) when

compared with controls.

There is slight decrease in the frequency of arch patterns in both hands

of CAD except in D3 of left hand but no statistically significant difference in

any digit when compared with controls.


Table 13: Frequency distribution of Different Finger Tip Patterns in CAD

and Controls

Subject S Side TOTAL TOTAL TOTAL E LOOPS ARCHES WHORLS X No % No % No %CAD M R 296 49.3 38 6.3 266 44.3(Cases) L 312 52.0 37 6.2 251 41.8 R+L 608 50.7 75 6.3 517 43.1 F R 89 59.3 13 8.7 48 32.0 L 82 54.7 14 9.3 54 36.0 R+L 171 57.0 27 9.0 102 34.0 M+F R 385 51.3 51 6.8 314 41.9 L 394 52.5 51 6.8 305 40.7 R+L 779 51.9 102 6.8 619 41.3Controls M R 325 54.2 50 8.3 225 37.5(Normal) L 360 60.0 44 7.3 196 32.7 R+L 685 57.1 94 7.8 421 35.1 F R 96 64.0 16 10.7 38 25.3 L 89 59.3 14 9.3 47 31.3 R+L 185 61.7 30 10.0 85 28.3 M+F R 421 56.1 66 8.8 263 35.1 L 449 59.9 58 7.7 243 32.4 R+L 870 58.0 124 8.3 506 33.7

Table 14 (a): Statistical Comparison of different Finger Tip Pattern between

CAD and Controls in Males and Females.

SEX Subject FINGER TIP PATTERNS LOOPS ARCHES WHORLSMALE CAD 608 75 517 CONTROL 685 94 421 Chi Sq 9.68 0.03 0.05

P-Value 0.0018579 0.1509736 0.0000706 Remark S NS SFEMALE CAD 171 27 102 CONTROL 185 30 85 Chi Sq 1.71 0.008 1.99

P-Value 0.2799481 0.7806566 0.1584624


Remark NS NS NSM+F CAD 779 102 619

CONTROL 870 124 506 Chi Sq 10.91 2.11 17.84

P-Value 0.0009571 0.1463103 0.0000240 Remark S NS S

Table 14 (b): Statistical Comparison of different Finger Tip Pattern between

CAD and Controls in both hands.

SIDE Subject FINGER TIP PATTERNS LOOPS ARCHES WHORLSRT HAND CAD 385 51 314 CONTROL 421 66 263 Chi Sq 3.28 1.82 7.04

P-Value 0.0699164 0.1776786 0.0079651 Remark NS NS SLT HAND CAD 394 51 305 CONTROL 449 58 243 Chi Sq 7.90 0.36 10.70

P-Value 0.0049505 0.5506489 0.0010721 Remark S NS S

Table 13 shows frequency distribution of different Finger Tip Patterns in total

CAD and controls. Table 14 shows statistical comparison of different Finger

Tip Patterns between CAD and controls in (a) Males and Females and (b)

Right Hand and Left Hand

In CAD males, the loop are seen in 50.7%, arches in 6.3% and whorls

in 43.1% whereas in Control males, the loops are seen in 57.1%, arches in

7.8% and whorls in 35.1%. Thus, there is decrease in the percentage of

loops/ arch pattern and increase in the percentage of whorl pattern in CAD

males with statistically significant difference is seen in loop pattern (P<0.01)

and whorl pattern (P<0.001).

In CAD females, the loops are seen in 57%, arches in 9% and whorls

in 34%. Whereas in Control females, the loops are seen in 61.7%, arches in

10% and whorls in 28.3%. Thus, there is decrease in the percentage of loops/

arch pattern and increase in the percentage of whorl pattern in CAD females

but no statistically significant difference is seen in any Finger Tip Patterns.

In CAD (M+F) combined series, the percentage of loops, arches and

whorls is 51.9%, 6.8% and 41.3% respectively while in controls (M+F), it is


58%, 8.3% and 33.7% respectively. Thus there is overall decrease in the

frequency of loop and arches; and significant increase in the frequency of

whorls in CAD (M+F) with statistically significant difference is seen in loop

pattern (P<0.001) and whorl pattern (P<0.0001).

In Right hand and Left hand also, there is decrease in the percentage

of loops/ arch pattern and increase in the percentage of whorl pattern in CAD

as compared to the controls with statistically significant difference is seen in

whorl pattern in Right hand (P<0.01) and loop pattern and whorl pattern in

Left hand (P<0.01).

II. QUANTITATIVE CHARACTERISTICS OF FINGER PATTERNS: RIDGE

COUNT

Holt SB (1961)55 stated that the ridge counts, which are size related numerical

representatives of pattern types are considered to be of greatest significance

in genetic terms. The absolute and total ridge counts effectively summarise

the quantitative characteristics of all digits of either hands.

Table 15: Frequency distribution of Total Finger Ridge Count (TFRC) in

Different Groups of CAD

CI SVD DVD TVD Total Cases of TFRC M F T % M F T % M F T % M F T %0-25 0 1 1 1.9 0 0 0 0.0 0 0 0 0.0 0 1 1 0.726-50 1 1 2 3.8 2 0 2 4.9 1 0 1 1.8 4 1 5 3.351-75 1 0 1 1.9 0 0 0 0.0 1 2 3 5.4 2 2 4 2.776-100 2 1 3 5.7 0 1 1 2.4 2 0 2 3.6 4 2 6 4.0101-125 7 0 7 13.2 8 0 8 19.5 7 0 7 12.5 22 0 22 14.7126-150 4 3 7 13.2 8 2 10 24.4 11 3 14 25.0 23 8 31 20.7151-175 16 5 21 39.6 4 4 8 19.5 11 2 13 23.2 31 11 42 28.0176-200 9 1 10 18.9 10 0 10 24.4 7 4 11 19.6 26 5 31 20.7201-225 0 0 0 0.0 2 0 2 4.9 3 0 3 5.4 5 0 5 3.3226-250 1 0 1 1.9 0 0 0 0.0 2 0 2 3.6 3 0 3 2.0251-275 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0276-300 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0301-325 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0


326-350 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0351-375 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0376-400 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0>401 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0Total 41 12 53 100.0 34 7 41 100.0 45 11 56 100.0 120 30 150 100.0

Table 15 shows frequency distribution of TFRC in different groups of CAD. In

SVD, the maximum percentage of TFRC is 39.6% seen in class interval of

151-175. While in DVD, it is seen in class interval of 176-200 and 126-150

(24.4 % each) and in TVD, it is seen in class interval of 126-150 (25%) and

151-175 (23.2%).

Table 16: Statistical Calculation of TFRC count in different Groups of CAD and

Controls

Groups TFRC Mean SD SE-M CVControls 142.00 46.85 3.83 32.99SVD 147.64 44.77 6.15 30.33DVD 147.76 39.24 6.13 26.56TVD 151.71 42.33 5.66 27.90

Table 16 shows statistical calculation of TFRC in different Groups of CAD and

controls. There is increase in the mean value of TFRC in all groups of CAD as

compared to the controls.

Table 17: Test of Significance for TFRC for comparison between different

Groups of CAD and Controls

Comparison t- Std T P Remarkwith Controls value value value SVD 0.762 1.972 0.447 NSDVD 0.721 1.973 0.472 NSTVD 1.358 1.972 0.176 NS

Table 17 shows ‘t’ value for TFRC for comparison between different Groups of

CAD and controls with their statistical significance. There is no statistical

significant difference in the mean value of TFRC in different groups of CAD

when compared with controls.

Table 18: Frequency distribution of Total Finger Ridge Count (TFRC) in total

CAD and Controls


CI CAD (Cases) Controls of TFRC M F T % M F T %0-25 0 1 1 0.7 0 1 1 0.726-50 4 1 5 3.3 6 2 8 5.351-75 2 2 4 2.7 5 1 6 4.076-100 5 1 6 4.0 10 2 12 8.0101-125 21 1 22 14.7 17 6 23 15.3126-150 23 8 31 20.7 21 9 30 20.0151-175 31 11 42 28.0 20 8 28 18.7176-200 26 5 31 20.7 27 0 27 18.0201-225 5 0 5 3.3 13 1 14 9.3226-250 3 0 3 2.0 1 0 1 0.7251-275 0 0 0 0.0 0 0 0 0.0276-300 0 0 0 0.0 0 0 0 0.0301-325 0 0 0 0.0 0 0 0 0.0326-350 0 0 0 0.0 0 0 0 0.0351-375 0 0 0 0.0 0 0 0 0.0376-400 0 0 0 0.0 0 0 0 0.0>401 0 0 0 0.0 0 0 0 0.0Total 120 30 150 100.0 120 30 150 100.0

Table 18 shows frequency distribution of TFRC in total CAD and controls.

There is increase in the TFRC in CAD as compared to the control. In CAD

cases, maximum percentage of TFRC is seen in class interval of 151-175

(28%) as compared to the control where it is seen in the class interval of 126-

150 (20%).

Table 19: Statistical Calculation for TFRC in total CAD and Controls

Subject Sex Mean SD SE-M CVCases M 150.88 41.48 3.79 27.49(CAD) F 142.43 44.92 8.20 31.54 M+F 149.19 42.17 3.44 28.27Controls M 146.19 46.66 4.26 31.92(Normal) F 125.23 44.47 8.12 35.51 M+F 142.00 46.85 3.83 32.99

Table 19 shows statistical calculation for TFRC in total CAD and controls.

There is increase in the mean value of TFRC in CAD males and females, and

also in CAD (M+F) when compared with the controls.

Table 20: Test of Significance for TFRC for comparison between total

CAD and Controls


Comparison t- Std T P Remark value value valueNMxCM 0.823 1.970 0.41 NSNF x CF 1.490 2.002 0.14 NSN(M+F)xC(M+F) 1.397 1.968 0.16 NS

Table 20 shows ‘t’ value of different comparison groups with their statistical

significance for TFRC in CAD and controls. There is no statistically significant

difference in the mean value of TFRC in all comparison groups.

Table 21: Frequency distribution of Absolute Finger Ridge Count (AFRC) in


CI SVD DVD TVD Total Cases of AFRC M F T % M F T % M F T % M F T %0-25 0 1 1 1.9 0 0 0 0.0 0 0 0 0.0 0 1 1 0.726-50 1 1 2 3.8 1 0 1 2.4 1 0 1 1.8 3 1 4 2.751-75 1 0 1 1.9 1 0 1 2.4 1 1 2 3.6 3 1 4 2.776-100 2 0 2 3.8 0 0 0 0.0 2 1 3 5.4 4 1 5 3.3101-125 3 1 4 7.5 6 1 7 17.1 2 0 2 3.6 11 2 13 8.7126-150 2 1 3 5.7 5 1 6 14.6 4 0 4 7.1 11 2 13 8.7151-175 3 4 7 13.2 3 2 5 12.2 5 1 6 10.7 11 7 18 12.0176-200 9 1 10 18.9 5 0 5 12.2 8 3 11 19.6 22 4 26 17.3201-225 5 0 5 9.4 1 2 3 7.3 7 1 8 14.3 13 3 16 10.7226-250 5 0 5 9.4 4 1 5 12.2 2 2 4 7.1 11 3 14 9.3251-275 2 1 3 5.7 2 0 2 4.9 5 0 5 8.9 9 1 10 6.7276-300 2 1 3 5.7 1 0 1 2.4 2 1 3 5.4 5 2 7 4.7301-325 3 0 3 5.7 3 0 3 7.3 3 1 4 7.1 9 1 10 6.7326-350 2 1 3 5.7 1 0 1 2.4 1 0 1 1.8 4 1 5 3.3351-375 1 0 1 1.9 1 0 1 2.4 0 0 0 0.0 2 0 2 1.3376-400 0 0 0 0.0 0 0 0 0.0 2 0 2 3.6 2 0 2 1.3


>401 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0Total 41 12 53 100.0 34 7 41 100.0 45 11 56 100.0 120 30 150 100.0

Table 21 shows frequency distribution of AFRC in different groups of CAD. In

SVD, the maximum percentage of AFRC is 18.9% seen in the class interval of

176-200. While in DVD, it is seen in the class interval of 101-125 (17.1%). In

TVD, the maximum percentage is seen in class interval of 176-200(19.6%).

Table 22: Statistical Calculation of AFRC count in different Groups of CAD and

Controls

Groups AFRC Mean SD SE-M CVControls 184.68 83.58 6.82 45.25SVD 196.58 83.05 11.41 42.25DVD 190.39 76.69 11.98 40.28TVD 205.93 78.44 10.48 38.09

Table 22 shows statistical calculation of AFRC in different Groups of CAD and

controls. There is increase in the mean value of AFRC in all groups of CAD as


Table 23: Test of Significance for AFRC for comparison between different


Comparison t- Std T P Remarkwith Controls value value valueSVD 0.892 1.972 0.373 NSDVD 0.394 1.973 0.694 NSTVD 1.986 1.972 0.049 S

Table 23 shows ‘t’ value for AFRC for comparison between different Groups

of CAD and controls with their statistical significance. There is no statistical

significant difference in the mean value of AFRC in different groups of CAD

when compared with controls except TVD (P<0.05).

Table 24: Frequency distribution of Absolute Finger Ridge Count (AFRC) in

total CAD and Controls

CI Cases (CAD) Controls of AFRC M F T % M F T %0-25 0 1 1 0.7 0 1 1 0.7


26-50 3 1 4 2.7 4 2 6 4.051-75 3 1 4 2.7 7 1 8 5.376-100 4 1 5 3.3 9 1 10 6.7101-125 11 2 13 8.7 9 5 14 9.3126-150 11 2 13 8.7 10 3 13 8.7151-175 11 7 18 12.0 17 6 23 15.3176-200 22 4 26 17.3 15 1 16 10.7201-225 13 3 16 10.7 6 7 13 8.7226-250 11 3 14 9.3 8 2 10 6.7251-275 9 1 10 6.7 11 0 11 7.3276-300 5 2 7 4.7 7 0 7 4.7301-325 9 1 10 6.7 8 0 8 5.3326-350 4 1 5 3.3 7 0 7 4.7351-375 2 0 2 1.3 1 1 2 1.3376-400 2 0 2 1.3 1 0 1 0.7>401 0 0 0 0.0 0 0 0 0.0Total 120 30 150 100.0 120 30 150 100.0

Table 24 shows frequency distribution of AFRC in total CAD cases and

controls. There is increase in the AFRC in CAD as compared to the controls.

In CAD, maximum percentage of AFRC is seen in class interval of 176-200

(17.3%) as compared to the controls where it is seen in the class interval of

151-175 (15.3%).

Table 25: Statistical Calculation for AFRC in total CAD and Controls

Subject Sex Mean SD SE-M CVCases M 202.03 80.13 7.32 39.66(CAD) F 183.77 75.71 13.82 41.20 M+F 198.38 79.36 6.48 40.00Controls M 191.43 85.25 7.78 44.53(Normal) F 157.67 71.57 13.07 45.39 M+F 184.68 83.58 6.82 45.25

Table 25 shows statistical calculation for AFRC in total CAD and controls.

There is increase in the mean value of AFRC in CAD males, CAD females

and also in CAD (M+F) when compared with the controls.

Table 26: Test of Significance for AFRC for comparison between total

CAD and Controls

Comparison t- Std T P Remarkswith Controls value value value


NMxCM 0.992 1.970 0.322 NSNF x CF 1.372 2.002 0.175 NSN(M+F)xC(M+F) 1.456 1.968 0.146 NS

Table 26 shows ‘t’ value of different comparison groups in CAD and controls

with their statistical significance for AFRC. There is no statistically significant

difference in the mean value of AFRC in all comparison groups.

III. QUANTITATIVE ANALYSIS OF PALMAR PATTERNS:

Galton F (1892)39 classified quantitative categories of total palmar pattern

types as shown in table 27 to 30. These quantitative pattern types are

subjected to chi-square test. The comparisons are made among calculated

chi-square value with standard chi-square probability table to see significance

of observation. These chi-square values and their statistical significance are

shown in respective table.

Table 27: Frequency Distribution of True Palmar Patterns in Different Groups of

CAD and Controls

Groups Sex Side Hypo % Th % ID1 % ID2 % ID3 % ID4 % Total %

SVD M R 36 87.8 21 51.2 2 4.9 6 14.6 22 53.7 20 48.8 107 43.5m=41 L 34 82.9 19 46.3 4 9.8 3 7.3 11 26.8 24 58.5 95 38.6f=12 R+L 70 85.4 40 48.8 6 7.3 9 11.0 33 40.2 44 53.7 202 41.1t=53 F R 12 100.0 3 25.0 0 0.0 0 0.0 4 33.3 9 75.0 28 38.9 L 10 83.3 3 25.0 1 8.3 0 0.0 2 16.7 7 58.3 23 31.9 R+L 22 91.7 6 25.0 1 4.2 0 0.0 6 25.0 16 66.7 51 35.4 M+F R 48 90.6 24 45.3 2 3.8 6 11.3 26 49.1 29 54.7 135 42.5 L 44 83.0 22 41.5 5 9.4 3 5.7 13 24.5 31 58.5 118 37.1 R+L 92 86.8 46 43.4 7 6.6 9 8.5 39 36.8 60 56.6 253 39.8DVD M R 30 88.2 8 23.5 0 0.0 5 14.7 21 61.8 11 32.4 75 36.8m=34 L 30 88.2 16 47.1 0 0.0 2 5.9 14 41.2 16 47.1 78 38.2f=7 R+L 60 88.2 24 35.3 0 0.0 7 10.3 35 51.5 27 39.7 153 37.5t=41 F R 7 100.0 0 0.0 0 0.0 0 0.0 1 14.3 6 85.7 14 33.3 L 6 85.7 1 14.3 1 14.3 1 14.3 2 28.6 5 71.4 16 38.1 R+L 13 92.9 1 7.1 1 7.1 1 7.1 3 21.4 11 78.6 30 35.7 M+F R 37 90.2 8 19.5 0 0.0 5 12.2 22 53.7 17 41.5 89 36.2 L 36 87.8 17 41.5 1 2.4 3 7.3 16 39.0 21 51.2 94 38.2 R+L 73 89.0 25 30.5 1 1.2 8 9.8 38 46.3 38 46.3 183 37.2TVD M R 39 86.7 17 37.8 1 2.2 5 11.1 26 57.8 22 48.9 110 40.7


m=45 L 39 86.7 27 60.0 4 8.9 2 4.4 15 33.3 28 62.2 115 42.6f=11 R+L 78 86.7 44 48.9 5 5.6 7 7.8 41 45.6 50 55.6 225 41.7t=56 F R 7 63.6 1 9.1 1 9.1 0 0.0 5 45.5 4 36.4 18 27.3 L 6 54.5 0 0.0 0 0.0 0 0.0 3 27.3 4 36.4 13 19.7 R+L 13 59.1 1 4.5 1 4.5 0 0.0 8 36.4 8 36.4 31 23.5 M+F R 46 82.1 18 32.1 2 3.6 5 8.9 31 55.4 26 46.4 128 38.1 L 45 80.4 27 48.2 4 7.1 2 3.6 18 32.1 32 57.1 128 38.1 R+L 91 81.3 45 40.2 6 5.4 7 6.3 49 43.8 58 51.8 256 38.1Controls M R 106 88.3 44 36.7 2 1.7 8 6.7 79 65.8 58 48.3 297 41.3m=120 L 102 85.0 67 55.8 9 7.5 7 5.8 47 39.2 84 70.0 316 43.9f=30 R+L 208 86.7 111 46.3 11 4.6 15 6.3 126 52.5 142 59.2 613 42.6t=150 F R 23 76.7 8 26.7 0 0.0 2 6.7 21 70.0 13 43.3 67 37.2 L 23 76.7 13 43.3 3 10.0 0 0.0 6 20.0 18 60.0 63 35.0 R+L 46 76.7 21 35.0 3 5.0 2 3.3 27 45.0 31 51.7 130 36.1 M+F R 129 86.0 52 34.7 2 1.3 10 6.7 100 66.7 71 47.3 364 40.4 L 125 83.3 80 53.3 12 8.0 7 4.7 53 35.3 102 68.0 379 42.1 R+L 254 84.7 132 44.0 14 4.7 17 5.7 153 51.0 173 57.7 743 41.3

Table 27 shows frequency distribution of true palmar patterns in different

groups of CAD and Table 28 shows statistical comparison with controls. The

total percentage of true palmar patterns is 39.8%, 37.2% and 38.1% in SVD,

DVD and TVD respectively. In all groups, palmar patterns are predominantly

seen in hypothenar area followed by ID4 area and ID3 area.

In SVD, there is decrease in the percentage of true palmar pattern in all

areas except hypothenar, ID1 and ID2 area with statistically significant

difference in ID3 area (P<0.05).

In DVD, there is decrease in the percentage of true palmar pattern in

all areas except hypothenar and ID2 area with statistically significant

difference in thenar area (P<0.05).

In TVD, there is decrease in the percentage of true palmar pattern in all

areas except ID1 and ID2 area with no statistically significant difference is

seen in any area.

Table 28: Statistical Comparison of true Palmar Pattern between different


Groups TRUE PALMAR PATTERNS IN DIFFERENT AREAS Sum


of CAD HYPO THENAR ID-1 ID-2 ID-3 ID-4 TotalControls 254 132 14 17 153 173 743% 84.7 44.0 4.7 5.7 51.0 57.7 41.3SVD 92 46 7 9 39 60 253% 86.8 43.4 6.6 8.5 36.8 56.6 39.8Chi Sq 0.14 0.01 0.27 0.62 5.79 0.01 0.38P-Value 0.7106865 0.9142420 0.6037673 0.4294973 0.0161583 0.9394374 0.5394859Remark NS NS NS NS S NS NSDVD 73 25 1 8 38 38 183% 89.0 30.5 1.2 9.8 46.3 46.3 37.2Chi Sq 0.67 4.31 1.22 1.16 0.39 2.9 2.51P-Value 0.4130006 0.0377808 0.2085598 0.2823646 0.5332411 0.0886800 0.1132812Remark NS S NS NS NS NS NSTVD 91 45 6 7 49 58 256% 81.3 40.2 5.4 6.3 43.8 51.8 38.1Chi Sq 0.47 0.34 0.08/ 0.00 0.00 1.44 0.92 1.93P-Value 0.4926545 0.5583472 0.9740607 0.9908444 0.2305501 0.3377942 0.1649691Remark NS NS NS NS NS NS NS

Table 29: Frequency Distribution of True Palmar Patterns in total CAD and

Controls

Subject Sex Side Hypo % Th % ID1 % ID2 % ID3 % ID4 % Total %

CAD M R 105 87.5 46 38.3 3 2.5 16 13.3 69 57.5 53 44.2 292 40.6 L 103 85.8 62 51.7 8 6.7 7 5.8 40 33.3 68 56.7 288 40.0

m=120 R+L 208 86.7 108 45.0 11 4.6 23 9.6 109 45.4 121 50.4 580 40.3f=30 F R 26 86.7 4 13.3 1 3.3 0 0.0 10 33.3 19 63.3 60 33.3t=150 L 22 73.3 4 13.3 2 6.7 1 3.3 7 23.3 16 53.3 52 28.9 R+L 48 80.0 8 13.3 3 5.0 1 1.7 17 28.3 35 58.3 112 31.1 M+F R 131 87.3 50 33.3 4 2.7 16 10.7 79 52.7 72 48.0 352 39.1 L 125 83.3 66 44.0 10 6.7 8 5.3 47 31.3 84 56.0 340 37.8 R+L 256 85.3 116 38.7 14 4.7 24 8.0 126 42.0 156 52.0 692 38.4Control M R 106 88.3 44 36.7 2 1.7 8 6.7 79 65.8 58 48.3 297 41.3m=120 L 102 85.0 67 55.8 9 7.5 7 5.8 47 39.2 84 70.0 316 43.9f=30 R+L 208 86.7 111 46.3 11 4.6 15 6.3 126 52.5 142 59.2 613 42.6t=150 F R 23 76.7 8 26.7 0 0.0 2 6.7 21 70.0 13 43.3 67 37.2 L 23 76.7 13 43.3 3 10.0 0 0.0 6 20.0 18 60.0 63 35.0 R+L 46 76.7 21 35.0 3 5.0 2 3.3 27 45.0 31 51.7 130 36.1 M+F R 129 86.0 52 34.7 2 1.3 10 6.7 100 66.7 71 47.3 364 40.4 L 125 83.3 80 53.3 12 8.0 7 4.7 53 35.3 102 68.0 379 42.1 R+L 254 84.7 132 44.0 14 4.7 17 5.7 153 51.0 173 57.7 743 41.3

Table 29 shows frequency distribution of true palmar pattern in total CAD and

controls. The percentage of total palmar patterns is 40.3% in CAD males and


42.6% in control males. Whereas, true palmar pattern is seen in 31.1% in

CAD females and 36.1% in control females.

In CAD males, the percentage of palmar patterns is 86.7%, 50.4%,

45.4% and 45% in hypothenar area, ID4 area, ID3 area and thenar area

respectively whereas in control males it is 86.7%, 59.2% 52.5% and 46.3% in

hypothenar, ID4, ID3 and thenar area respectively.

In CAD females, the percentage of palmar pattern is 80%, 58.3%,

28.3% and 13.3% in hypothenar, ID4, ID3 and thenar areas whereas in

control females it is 76.7%, 51.7%, 45% and 35% in hypothenar, ID4, ID3 and

thenar area.

In CAD (M+F), the percentage of palmar patterns is 85.3%, 52%, 42%

and 38.7% in hypothenar, ID4, ID3, and thenar area as compared to 84.7%,

57.7%, 51% and 44% respectively in controls (M+F).

In right hand, the percentage of palmar patterns is 87.3%, 52.7% and

48% in hypothenar, ID3 and ID4 area in CAD cases as compared to 86%,

66.7% and 47.3% respectively in controls.

In left hand, the percentage of palmar patterns is 83.3%, 56% and 44%

in hypothenar, ID4 and thenar area in CAD cases as compared to 83.3%,

68% and 53.3% respectively in controls.

Table 30 (a): Statistical Comparison of true Palmar Pattern between CAD and

Controls in Males and Females.

SEX Subject TRUE PALMAR PATTERNS IN DIFFERENT AREAS Sum HYPO THENAR ID-1 ID-2 ID-3 ID-4 TotalM CAD 208 108 11 23 109 121 580 CONTROL 208 111 11 15 126 142 613 Chi Sq 0.02 0.03 0.05 1.4 2.53 3.36 1.47

P-Value 0.8931879 0.8545806 0.8272256 0.2366678 0.1119504 0.0666267 0.2260832 Remark NS NS NS NS NS NS NSF CAD 48 8 3 1 17 35 112 CONTROL 46 21 3 2 27 31 130 Chi Sq 0.05 6.55 0.18 0.00/0.34 2.91 0.3 1.8

P-Value 0.8246371 0.0105006 1.0000000 1.0000000 0.0882123 0.5819889 0.1798555 Remark NS S NS NS NS NS NSM+F CAD 256 116 14 24 126 156 692

CONTROL 254 132 14 17 153 173 743 Chi Sq 0.01 1.55 0.04 0.94 4.53 1.72 2.9

P-Value 0.9089743 0.2136584 0.8465264 0.3316487 0.0333278 0.1893375 0.0887504


Remark NS NS NS NS S NS NS

Table 30 (b): Statistical Comparison of true Palmar Pattern between CAD and

Controls in both hands

SIDE Subject TRUE PALMAR PATTERNS IN DIFFERENT AREAS Sum HYPO THENAR ID-1 ID-2 ID-3 ID-4 TotalR CAD 131 50 4 16 79 72 352 CONTROL 129 52 2 10 100 71 364 Chi Sq 0.03 0.01 0.17 1.05 5.54 0.00/0.01 0.28

P-Value 0.8651347 0.9029951 0.6843327 0.3048678 0.0185821 1.0000000 0.5962964 Remark NS NS NS NS S NS NSL CAD 125 66 10 8 47 84 340 CONTROL 125 80 12 7 53 102 379 Chi Sq 0.02 2.25 0.05 0.00/0.07 0.38 4.09 3.34

P-Value 0.8768849 0.1331889 0.8247217 1.0000000 0.5402914 0.043167 0.0674445 Remark NS NS NS NS NS S NS

Table 30 shows statistical comparison of true palmar patterns between CAD

and controls in (a) Males and Females and (b) Right Hand and Left Hand.

There is decrease in the frequency of palmar pattern in CAD males in

all areas except ID2 area, but no statistically significant difference is seen in

any areas when compared with controls.

In CAD females also there is decrease in the frequency of palmar

pattern in all areas except hypothenar and ID4 area with statistically

significant difference is seen in thenar (P<0.05).

In CAD (M+F) combined series, there is decrease in the frequency of

palmar pattern in all areas except hypothenar, ID1 and ID2 area with

statistically significant difference is seen in ID3 area (P<0.05).

Moreover, in Right hand, there is decrease in the frequency of palmar

pattern in all areas of CAD cases except hypothenar, ID1, ID2 and ID4 area

with statistically significant difference is seen in ID3 area (P<0.05).

In Left hand, there is decrease in the frequency of palmar pattern in all

areas of CAD cases except ID2 area with statistically significant difference is

seen in ID4 area (P<0.05).


IV. POSITION OF AXIAL TRIRADII:

Table 31: Frequency Distribution of Position of Axial Triradii in Different Groups of

CAD

Groups Sex Si t t' t" t t' tt" t' t" t' + t t' t" + tt" DDA de No % No % No % No % No % No % No % No % No %SVD M R 32 78.0 5 12.2 0 0.0 2 4.9 2 4.9 0 0.0 7 17.1 2 4.9 9 22.0m=41 L 25 61.0 6 14.6 1 2.4 5 12.2 4 9.8 0 0.0 11 26.8 5 12.2 16 39.0f=12 R+L 57 69.5 11 13.4 1 1.2 7 8.5 6 7.3 0 0.0 18 22.0 7 8.5 25 30.5t=53 F R 8 66.7 3 25.0 0 0.0 1 8.3 0 0.0 0 0.0 4 33.3 0 0.0 4 33.3 L 9 75.0 2 16.7 0 0.0 1 8.3 0 0.0 0 0.0 3 25.0 0 0.0 3 25.0 R+L 17 70.8 5 20.8 0 0.0 2 8.3 0 0.0 0 0.0 7 29.2 0 0.0 7 29.2 M+F R 40 75.5 8 15.1 0 0.0 3 5.7 2 3.8 0 0.0 11 20.8 2 3.8 13 24.5 L 34 64.2 8 15.1 1 1.9 6 11.3 4 7.5 0 0.0 14 26.4 5 9.4 19 35.8 R+L 74 69.8 16 15.1 1 0.9 9 8.5 6 5.7 0 0.0 25 23.6 7 6.6 32 30.2DVD M R 26 76.5 5 14.7 1 2.9 2 5.9 0 0.0 0 0.0 7 20.6 1 2.9 8 23.5m=34 L 28 82.4 4 11.8 1 2.9 0 0.0 1 2.9 0 0.0 4 11.8 2 5.9 6 17.6f=7 R+L 54 79.4 9 13.2 2 2.9 2 2.9 1 1.5 0 0.0 11 16.2 3 4.4 14 20.6t=41 F R 5 71.4 1 14.3 0 0.0 1 14.3 0 0.0 0 0.0 2 28.6 0 0.0 2 28.6 L 6 85.7 1 14.3 0 0.0 0 0.0 0 0.0 0 0.0 1 14.3 0 0.0 1 14.3 R+L 11 78.6 2 14.3 0 0.0 1 7.1 0 0.0 0 0.0 3 21.4 0 0.0 3 21.4 M+F R 31 75.6 6 14.6 1 2.4 3 7.3 0 0.0 0 0.0 9 22.0 1 2.4 10 24.4 L 34 82.9 5 12.2 1 2.4 0 0.0 1 2.4 0 0.0 5 12.2 2 4.9 7 17.1 R+L 65 79.3 11 13.4 2 2.4 3 3.7 1 1.2 0 0.0 14 17.1 3 3.7 17 20.7TVD M R 36 80.0 5 11.1 0 0.0 2 4.4 2 4.4 0 0.0 7 15.6 2 4.4 9 20.0m=45 L 32 71.1 6 13.3 0 0.0 5 11.1 2 4.4 0 0.0 11 24.4 2 4.4 13 28.9f=11 R+L 68 75.6 11 12.2 0 0.0 7 7.8 4 4.4 0 0.0 18 20.0 4 4.4 22 24.4t=56 F R 6 54.5 4 36.4 0 0.0 1 9.1 0 0.0 0 0.0 5 45.5 0 0.0 5 45.5


L 6 54.5 5 45.5 0 0.0 0 0.0 0 0.0 0 0.0 5 45.5 0 0.0 5 45.5 R+L 12 54.5 9 40.9 0 0.0 1 4.5 0 0.0 0 0.0 10 45.5 0 0.0 10 45.5 M+F R 42 75.0 9 16.1 0 0.0 3 5.4 2 3.6 0 0.0 12 21.4 2 3.6 14 25.0 L 38 67.9 11 19.6 0 0.0 5 8.9 2 3.6 0 0.0 16 28.6 2 3.6 18 32.1 R+L 80 71.4 20 17.9 0 0.0 8 7.1 4 3.6 0 0.0 28 25.0 4 3.6 32 28.6Control M R 99 82.5 10 8.3 1 0.8 7 5.8 2 1.7 1 0.8 17 14.2 3 2.5 20 16.7m=120 L 96 80.0 10 8.3 0 0.0 9 7.5 5 4.2 0 0.0 19 15.8 5 4.2 24 20.0f=30 R+L 195 81.3 20 8.3 1 0.4 16 6.7 7 2.9 1 0.4 36 15.0 8 3.3 44 18.3t=150 F R 22 73.3 4 13.3 0 0.0 3 10.0 1 3.3 0 0.0 7 23.3 1 3.3 8 26.7 L 19 63.3 8 26.7 0 0.0 2 6.7 1 3.3 0 0.0 10 33.3 1 3.3 11 36.7 R+L 41 68.3 12 20.0 0 0.0 5 8.3 2 3.3 0 0.0 17 28.3 2 3.3 19 31.7 M+F R 121 80.7 14 9.3 1 0.7 10 6.7 3 2.0 1 0.7 24 16.0 4 2.7 28 18.7 L 115 76.7 18 12.0 0 0.0 11 7.3 6 4.0 0 0.0 29 19.3 6 4.0 35 23.3 R+L 236 78.7 32 10.7 1 0.3 21 7.0 9 3.0 1 0.3 53 17.7 10 3.3 63 21.0

Table 32: Statistical Comparison of Position of Axial Triradii between different


Groups POSITION OF AXIAL TRIRADII

of CAD t t' t" tt' tt" t't" t'+tt' t"+tt" DDA

Controls 236 32 1 21 9 1 53 10 63

% 78.7 10.7 0.3 7.0 3.0 0.3 17.7 3.3 21.0

SVD 74 16 1 9 6 0 25 7 32

% 69.8 15.1 0.9 8.5 5.7 0.0 23.6 6.6 30.2

Chi Sq 2.93 1.08 0.00/0.05 0.08 0.90 0.30 1.41 1.35 3.19

P-Value 0.08699 0.29896 0.45448 0.77311 0.23360 0.58601 0.23559 0.24483 0.07388

Remark NS NS NS NS NS NS NS NS NS

DVD 65 11 2 3 1 0 14 3 17

% 79.3 13.4 2.4 3.7 1.2 0 17.1 3.7 20.7

Chi Sq 0.00/0.01 0.25 1.46 0.72 0.25 0.48 0.00/0.02 0.04 0.01

P-Value 0.97262 0.61667 0.11769 0.39627 0.69622 0.48651 0.96921 0.84171 0.92017


TVD 80 20 0 8 4 0 28 4 32

% 71.4 17.9 0 7.1 3.6 0 25 3.6 28.6

Chi Sq 2 3.2 0.26 0.03 0.03 0.26 2.33 0.03 2.23

P-Value 0.15700 0.07368 0.60765 0.86815 0.85173 0.60765 0.12675 0.85173 0.13573


Table 31 shows frequency distribution of different position and distal

displacement of axial triradii in different groups of CAD and Table 32 shows

their statistical comparisons with controls. There is higher percentage of axial

triradii near wrist (t) in all groups of CAD with 69.9% in SVD, 79.3% in DVD

and 71.4% in TVD as compared to 78.7% in controls.


In SVD, there is increase in the percentage of axial triradii at t’, t”, tt’,

tt”, t’+tt’, t”+tt” and DDA position and decrease in the percentage of axial

triradii near wrist (t) as compared to the controls.

In DVD, there is increase in the percentage of axial triradii at t, t’, t”

position and decrease in the percentage of rest of position of axial triradii as


In TVD, there is increase in the percentage of axial triradii at t’, tt”, t’+tt’

and DDA position and decrease in the percentage of axial triradii near wrist (t)

as compared to the controls.

Thus there is decrease in the percentage of axial triradii near wrist (t)

with increase in the percentage of Distal Displacement (t’,tt”,t’+tt’) of Axial

triradii (DDA) position in both SVD and TVD but not statistically significant.

No statistically significant difference is seen in any position of axial triradii in

any groups of CAD when compared with the controls.

Table 33: Frequency Distribution of Position of Axial Triradii in total CAD and

Controls

SubjectSE Side t t' t" t t' tt" t' t" t' + t t' t" + tt" DDA

X No % No % No % No % No % No % No % No % No %CAD M R 94 78.3 15 12.5 1 0.8 6 5.0 4 3.3 0 0.0 21 17.5 5 4.2 26 21.7

L 85 70.8 16 13.3 2 1.7 10 8.3 7 5.8 0 0.0 26 21.7 9 7.5 35 29.2m=120 R+L 179 74.6 31 12.9 3 1.3 16 6.7 11 4.6 0 0.0 47 19.6 14 5.8 61 25.4f=30 F R 19 63.3 8 26.7 0 0.0 3 10.0 0 0.0 0 0.0 11 36.7 0 0.0 11 36.7t=150 L 21 70.0 8 26.7 0 0.0 1 3.3 0 0.0 0 0.0 09 30.0 0 0.0 9 30.0 R+L 40 66.7 16 26.7 0 0.0 4 6.7 0 0.0 0 0.0 20 33.3 0 0.0 20 33.3 M+F R 113 75.3 23 15.3 1 0.7 9 6.0 4 2.7 0 0.0 32 21.3 5 3.3 37 24.7 L 106 70.7 24 16.0 2 1.3 11 7.3 7 4.7 0 0.0 35 23.3 9 6.0 44 29.3 R+L 219 73.0 47 15.7 3 1.0 20 6.7 11 3.7 0 0.0 67 22.3 14 4.7 81 27.0Controls M R 99 82.5 10 8.3 1 0.8 7 5.8 2 1.7 1 0.8 17 14.2 3 2.5 20 16.7m=120 L 96 80.0 10 8.3 0 0.0 9 7.5 5 4.2 0 0.0 19 15.8 5 4.2 24 20.0f=30 R+L 195 81.3 20 8.3 1 0.4 16 6.7 7 2.9 1 0.4 36 15.0 8 3.3 44 18.3t=150 F R 22 73.3 4 13.3 0 0.0 3 10.0 1 3.3 0 0.0 07 23.3 1 3.3 8 26.7 L 19 63.3 8 26.7 0 0.0 2 6.7 1 3.3 0 0.0 10 33.3 1 3.3 11 36.7 R+L 41 68.3 12 20.0 0 0.0 5 8.3 2 3.3 0 0.0 17 28.3 2 3.3 19 31.7 M+F R 121 80.7 14 9.3 1 0.7 10 6.7 3 2.0 1 0.7 24 16.0 4 2.7 28 18.7 L 115 76.7 18 12.0 0 0.0 11 7.3 6 4.0 0 0.0 29 19.3 6 4.0 35 23.3 R+L 236 78.7 32 10.7 1 0.3 21 7.0 9 3.0 1 0.3 53 17.7 10 3.3 63 21.0

Table 33 shows frequency distribution of different position and distal

displacement of axial triradii in total CAD and controls. There is higher


percentage of axial triradii near wrist (t) in both CAD and controls. The

percentage of axial triradii t’+tt’ is 19.6% and t”+tt” is 5.8% in CAD males,

while in control males, the percentage of t’+tt’ is 15% and t”+tt” is 3.3%.

In CAD females, the percentage of axial triradii t’+tt’ is 33.3% and t”+tt”

is 0% as compared to 28.3% and 3.3% respectively in control females.

In CAD (M+F) combined series, the percentage of axial triradii t’+tt’ is

22.3% and t”+tt” is 4.7% as compared to 17.7% and 3.3% respectively in

control (M+F).

The percentage of Distal Displacement of Axial Triradii (DDA) in CAD

males is 25.4% and in control males is 18.3%. While it is 33.3% in CAD

females and 31.7% in control females.

In both right and left hand, there is increase in the percentage of distal

displacement of axial triradii.

Table 34 (a): Statistical Comparison of Position of Axial Triradii between CAD and


SEX Subject POSITION OF AXIAL TRIRADII t t' t" tt' tt" t't" t'+tt' t"+tt" DDAM CAD 179 31 3 16 11 0 47 14 61 CONTROL 195 20 1 16 7 1 36 8 44 Chi Sq 2.72 2.19 0.25 0.03 0.52 ---- 1.46 1.19 3.12

P-Value 0.09883 0.13856 0.62343 0.85481 0.47106 ---- 0.22745 0.27514 0.07730 Remark NS NS NS NS NS ---- NS NS NSF CAD 40 16 0 4 0 0 20 0 20 CONTROL 41 12 0 5 2 0 17 2 19 Chi Sq 0.04 0.42 -- 0.12 0.51 ---- 0.16 0.51 0.04

P-Value 0.84547 0.51731 -- 0.72890 0.49580 ---- 0.69259 0.49580 0.84547 Remark NS NS -- NS NS ---- NS NS NSM+F CAD 219 47 3 20 11 0 67 14 81

CONTROL 236 32 1 21 9 1 53 10 63 Chi Sq 2.33 2.86 0.25 0.03 0.05 ---- 1.76 0.39 2.64

P-Value 0.12705 0.09097 0.62374 0.87146 0.82009 ---- 0.18457 0.53197 0.10416 Remark NS NS NS NS NS ---- NS NS NS

Table 34 (b): Statistical Comparison of Position of Axial Triradii between CAD and

Controls in both hands.

SIDE Subject POSITION OF AXIAL TRIRADII t t' t" tt' tt" t't" t'+tt' t"+tt" DDAR CAD 113 23 1 9 4 0 32 5 37 CONTROL 121 14 1 10 3 1 24 4 28


Chi Sq 0.95 1.97 0.50 0.00 0.00 ---- 1.08 0.00 1.26P-Value 0.32926 0.16012 0.47803 1.00000 1.00000 ---- 0.29963 1.00000 0.26223

Remark NS NS NS NS NS ---- NS NS NSL CAD 106 24 2 11 7 0 35 9 44 CONTROL 115 18 0 11 6 0 29 6 35 Chi Sq 1.10 0.69 0.50 0.05 0.00 ---- 0.50 0.28 1.10

P-Value 0.29433 0.40544 0.47803 0.82472 1.00000 ---- 0.48102 0.59624 0.29433 Remark NS NS NS NS NS ---- NS NS NS

Table 34 shows chi-square values for statistical comparison of different

position of axial triradii between CAD and controls in (a) Males and Females

(b) Right and Left hand.

There is increase in the frequency of position of axial triradii at t’, t”, tt”

t’+tt’, t”+tt” and DDA in CAD males and t’, t’+tt’ in CAD females with decrease

in the frequency of axial triradii near wrist (t) in both sexes but no statistical

significance difference in any position of axial triradii when compared with the

controls.

In CAD (M+F) combined series, there is also increase in the frequency

of position of axial triradii at t’, t”, tt”, t’+tt’, t”+tt” and DDA with decrease in the

frequency of axial triradii near wrist (t) but no statistical significant difference in

any position of axial triradii when compared with the controls.

Similarly, there is increase in the frequency of axial triradii at t’, tt”, t’+tt’,

t”+tt” and DDA in both right and left hand with decrease in the frequency of

axial triradii near wrist (t) but no statistical significant difference in any position

of axial triradii when compared with the controls.

Thus there is increase frequency of DDA (t’, tt”, t’+tt’) and decrease

frequency of axial triradii near wrist (t) in CAD but no statistical significant

difference in any position of axial triradii in either sex or in right and left hand

when compared with the controls.


V. NUMBER OF PALMAR TRIRADII:

Table 35: Frequency Distribution of Number of Palmar Triradii in


Groups Sex Side 4 5 6 7 8 9 No % No % No % No % No % No %SVD M R 5 12.2 17 41.5 13 31.7 6 14.6 0 0.0 0 0.0m=41 L 4 9.8 16 39.0 13 31.7 7 17.1 1 2.4 0 0.0f=12 R+L 9 11.0 33 40.2 26 31.7 13 15.9 1 1.2 0 0.0t=53 F R 1 8.3 8 66.7 2 16.7 1 8.3 0 0.0 0 0.0 L 1 8.3 8 66.7 2 16.7 1 8.3 0 0.0 0 0.0 R+L 2 8.3 16 66.7 4 16.7 2 8.3 0 0.0 0 0.0 M+F R 6 11.3 25 47.2 15 28.3 7 13.2 0 0.0 0 0.0 L 5 9.4 24 45.3 15 28.3 8 15.1 1 1.9 0 0.0 R+L 11 10.4 49 46.2 30 28.3 15 14.2 1 0.9 0 0.0DVD M R 2 5.9 25 73.5 5 14.7 1 2.9 1 2.9 0 0.0m=34 L 1 2.9 26 76.5 5 14.7 1 2.9 1 2.9 0 0.0f=7 R+L 3 4.4 51 75.0 10 14.7 2 2.9 2 2.9 0 0.0t=41 F R 0 0.0 5 71.4 2 28.6 0 0.0 0 0.0 0 0.0 L 0 0.0 6 85.7 0 0.0 1 14.3 0 0.0 0 0.0 R+L 0 0.0 11 78.6 2 14.3 1 7.1 0 0.0 0 0.0 M+F R 2 4.9 30 73.2 7 17.1 1 2.4 1 2.4 0 0.0 L 1 2.4 32 78.0 5 12.2 2 4.9 1 2.4 0 0.0 R+L 3 3.7 62 75.6 12 14.6 3 3.7 2 2.4 0 0.0TVD M R 3 6.7 28 62.2 9 20.0 4 8.9 1 2.2 0 0.0m=45 L 2 4.4 25 55.6 10 22.2 6 13.3 2 4.4 0 0.0f=11 R+L 5 5.6 53 58.9 19 21.1 10 11.1 3 3.3 0 0.0t=56 F R 0 0.0 10 90.9 1 9.1 0 0.0 0 0.0 0 0.0 L 0 0.0 9 81.8 2 18.2 0 0.0 0 0.0 0 0.0 R+L 0 0.0 19 86.4 3 13.6 0 0.0 0 0.0 0 0.0 M+F R 3 5.4 38 67.9 10 17.9 4 7.1 1 1.8 0 0.0 L 2 3.6 34 60.7 12 21.4 6 10.7 2 3.6 0 0.0 R+L 5 4.5 72 64.3 22 19.6 10 8.9 3 2.7 0 0.0Controls M R 1 0.8 74 61.7 37 30.8 4 3.3 3 2.5 1 0.8m=120 L 1 0.8 59 49.2 48 40.0 9 7.5 2 1.7 1 0.8f=30 R+L 2 0.8 133 55.4 85 35.4 13 5.4 5 2.1 2 0.8t=150 F R 1 3.3 17 56.7 10 33.3 1 3.3 1 3.3 0 0.0 L 1 3.3 17 56.7 9 30.0 3 10.0 0 0.0 0 0.0 R+L 2 3.3 34 56.7 19 31.7 4 6.7 1 1.7 0 0.0


M+F R 2 1.3 91 60.7 47 31.3 5 3.3 4 2.7 1 0.7 L 2 1.3 76 50.7 57 38.0 12 8.0 2 1.3 1 0.7 R+L 4 1.3 167 55.7 104 34.7 17 5.7 6 2.0 2 0.7

Table 36: Statistical Comparison of Number of Palmar Triradii between

different groups of CAD with Controls.

Groups NUMBER OF PALMAR TRIRADII of CAD 4 5 6 7 8 9Controls 4 167 104 17 6 2% 1.3 55.7 34.7 5.7 2.0 0.7SVD 11 49 30 15 1 0% 10.4 46.2 28.3 14.2 0.9 0.0Chi Sq 15.55 2.44 1.16 6.64 0.08 0.0P-Value 0.0000802 0.1184849 0.2811403 0.0099671 0.7761360 0.9714613Remark S NS NS S NS NSDVD 3 62 12 3 2 0% 3.7 75.6 14.6 3.7 2.4 0.0Chi Sq 0.86 9.85 11.29 0.2 0.04 0.01P-Value 0.354099 0.0016956 0.0007782 0.6572240 0.8500247 0.9028631Remark NS S S NS NS NSTVD 5 72 22 10 3 0% 4.5 64.3 19.6 8.9 2.7 0.0Chi Sq 2.42 2.15 7.98 0.93 0.00 0.00P-Value 0.119822 0.1429470 0.0047360 0.3337330 0.9677337 0.9445075Remark NS NS S NS NS NS

Table 35 shows frequency distribution of number of palmar triradii in different

groups of CAD and Table 36 shows statistical comparison with the controls.

In SVD, there is increase in the percentage of ‘4’ and ‘7’ palmar triradii

and decrease in the percentage of ‘5’ and ‘6’ palmar triradii as compared to

the controls with statistically significant difference is seen in ‘4’ palmar triradii

(P<0.0001) and ‘7’ palmar triradii (P<0.01).

In DVD, there is increase in the percentage of ‘4’, and ‘5’ palmar triradii

and decrease in the percentage of ‘6’ palmar triradii as compared to the

controls with statistically significant difference is seen in ‘5’ palmar triradii


In TVD, there is increase in the percentage of ‘4’, ‘5’ and ‘7’ palmar

triradii and decrease in the percentage of ‘6’ palmar triradii as compared to


the controls with statistically significant difference is seen in ‘6’ palmar triradii

(P<0.01).

Table 37: Frequency Distribution of Number of Palmar Triradii in total CAD and

Controls

Subject Sex Side 4 5 6 7 8 9 No % No % No % No % No % No %CAD M R 10 8.3 70 58.3 27 22.5 11 9.2 2 1.7 0 0.0(Cases) L 7 5.8 67 55.8 28 23.3 14 11.7 4 3.3 0 0.0m=120 R+L 17 7.1 137 57.1 55 22.9 25 10.4 6 2.5 0 0.0f=30 F R 1 3.3 23 76.7 5 16.7 1 3.3 0 0.0 0 0.0t=150 L 1 3.3 23 76.7 4 13.3 2 6.7 0 0.0 0 0.0 R+L 2 3.3 46 76.7 9 15.0 3 5.0 0 0.0 0 0.0 M+F R 11 7.3 93 62.0 32 21.3 12 8.0 2 1.3 0 0.0 L 8 5.3 90 60.0 32 21.3 16 10.7 4 2.7 0 0.0 R+L 19 6.3 183 61.0 64 21.3 28 9.3 6 2.0 0 0.0Controls M R 1 0.8 74 61.7 37 30.8 4 3.3 3 2.5 1 0.8m=120 L 1 0.8 59 49.2 48 40.0 9 7.5 2 1.7 1 0.8f=30 R+L 2 0.8 133 55.4 85 35.4 13 5.4 5 2.1 2 0.8t=150 F R 1 3.3 17 56.7 10 33.3 1 3.3 1 3.3 0 0.0 L 1 3.3 17 56.7 9 30.0 3 10.0 0 0.0 0 0.0 R+L 2 3.3 34 56.7 19 31.7 4 6.7 1 1.7 0 0.0 M+F R 2 1.3 91 60.7 47 31.3 5 3.3 4 2.7 1 0.7 L 2 1.3 76 50.7 57 38.0 12 8.0 2 1.3 1 0.7 R+L 4 1.3 167 55.7 104 34.7 17 5.7 6 2.0 2 0.7

Table 38 (a): Statistical Comparison of Number of Palmar Triradii between CAD and


SEX Subject NUMBER OF PALMAR TRIRADII 4 5 6 7 8 9M CAD 17 137 55 25 6 0 CONTROL 2 133 85 13 5 2 Chi Sq 10.74 0.08 8.48 4.12 0.09 0.50

P-Value 0.0010479 0.7825279 0.0035894 0.0424979 0.7603458 0.4985562 Remark S NS S S NS NSF CAD 2 46 9 3 0 0 CONTROL 2 34 19 4 1 0 Chi Sq 0.26 4.54 4.66 0.15 0 ----

P-Value 0.6110693 0.0331600 0.0309022 0.6969097 1.0000000 ---- Remark NS S S NS NS ----M+F CAD 19 183 64 28 6 0

CONTROL 4 167 104 17 6 2


Chi Sq 8.86 1.54 12.57 2.40 0.09 0.50P-Value 0.0029126 0.2141930 0.0003911 0.1211491 0.7705879 0.4991653

Remark S NS S NS NS NS

Table 38 (b): Statistical Comparison of Number of Palmar Triradii between

CAD and Controls in both hands.

SIDE Subject NUMBER OF PALMAR TRIRADII 4 5 6 7 8 9R CAD 11 93 32 12 2 0 CONTROL 2 91 47 5 4 1 Chi Sq 5.15 0.01 3.87 2.24 0.17 0.00

P-Value 0.0232990 0.9056273 0.0492679 0.1340594 0.6800514 1.0000000 Remark S NS S NS NS NSL CAD 8 90 32 16 4 0 CONTROL 2 76 57 12 2 1 Chi Sq 2.59 2.28 9.20 0.35 0.17 0.00

P-Value 0.1077982 0.1311139 0.0024178 0.5515673 0.6800514 1.0000000 Remark NS NS S NS NS NS

Table 37 shows frequency distribution of number of palmar triradii in total

CAD and controls. Table 38 shows statistical comparison of number of palmar

triradii between CAD and controls in (a) Males and Females and (b) Right

hand and Left hand.

In CAD males, there is increase in the frequency of ‘4’, ‘5’ and ‘7’

palmar triradii and decrease in ‘6’ palmar triradii as compared to the controls

males with statistically significant difference is seen in ‘4’ palmar triradii

(P<0.01), ‘6’ palmar triradii (P<0.01) and ‘7’ palmar triradii (P<0.05).

In CAD females, there is increase in the frequency of ‘5’ palmar triradii

and decrease in ‘6’ palmar triradii as compared to the controls females with

statistically significant difference is seen in ‘5’ palmar triradii (P<0.05) and ‘6’

palmar triradii (P<0.05).

In CAD (M+F) combined series, there is increase in the frequency of

‘4’, ‘5’, and ‘7’ palmar triradii and decrease in ‘6’ palmar triradii as compared to

the controls (M+F) with statistically significant difference is seen in ‘4’ palmar

triradii (P<0.01) and ‘6’ palmar triradii (P<0.001).

In Right hand, there is increase in the frequency of ‘4’, ‘5’ and ‘7’

palmar triradii and decrease in ‘6’ palmar triradii in CAD as compared to the


controls with statistically significant difference is seen in ‘4’ palmar triradii


In Left hand, there is increase in the frequency of ‘4’, ‘5’ and ‘7’ palmar

triradii and decrease in ‘6’ palmar triradii in CAD as compared to the controls

with statistically significant difference is seen in ‘6’ palmar triradii (P<0.01).

VI. ab RIDGE COUNT:

Table 39: Statistical Calculation of ab-ridge count in different Groups of CAD and

Controls

Groups RIGHT HAND LEFT HAND MEAN SD SE-M CV MEAN SD SE-M CVControls 39.54 5.28 0.43 13.36 40.63 5.20 0.42 12.81SVD 39.40 4.73 0.65 12.00 40.04 4.90 0.67 12.24DVD 39.44 4.86 0.76 12.32 40.41 5.31 0.83 13.14TVD 39.45 5.20 0.70 13.19 40.38 5.58 0.75 13.83

Table 39 shows statistical calculation of ab ridge count in different groups of

CAD and controls. The mean value of ab ridge count in different groups of

CAD is slightly lower in both right and left hand as compared to the controls.

The mean value of ab ridge count in right hand is slightly lesser as

compared to left hand in all group of CAD and controls.

Table 40: Test of Significance for ab- ridge count for comparison between different


Comparison RIGHT HAND LEFT HAND with t- Std T- P Remark t- Std T- P RemarkControls value value value value value valueSVD 0.170 1.972 0.865 NS 0.721 1.972 0.472 NSDVD 0.109 1.973 0.913 NS 0.239 1.973 0.811 NSTVD 0.109 1.972 0.913 NS 0.301 1.972 0.764 NS

Table 40 shows t-value for ab ridge count for comparison between different

groups of CAD and controls. There is no statistically significant difference in

the mean value of ab ridge count in different groups of CAD when compared

to the controls.


Table 41: Frequency distribution of a-b ridge count in total CAD and Controls

ab MALE FEMALE Ridge CAD CONTROL CAD CONTROL Count R L T % R L T % R L T % R L T %26-30 2 2 4 1.7 4 2 6 2.5 1 1 2 3.3 2 2 4 6.731-35 17 16 33 13.8 24 15 39 16.3 7 8 15 25.0 4 2 6 10.036-40 52 54 106 44.2 48 48 96 40.0 12 6 18 30.0 6 6 12 20.041-45 39 29 68 28.3 32 40 72 30.0 7 5 12 20.0 13 16 29 48.346-50 7 16 23 9.6 7 10 17 7.1 2 8 10 16.7 4 4 8 13.351-55 3 2 5 2.1 5 3 8 3.3 1 2 3 5.0 1 0 1 1.756-60 0 1 1 0.4 0 2 2 0.8 0 0 0 0.0 0 0 0 0.0

Table 41 shows frequency distribution of ab ridge count in total CAD and

controls. In CAD males, maximum percentage of ab ridge count is seen

between 36-40 (44.2%) as compared to control males where it is seen

between 36-40 (40%). In CAD females, maximum percentage of ab ridge

count is seen between 36-40 (30%) as compared to control females where it

is seen between 41-45 interval (48.3%).

Table 42: Statistical Calculation for a-b Ridge Count in total CAD and Controls

Subject Sex Side MEAN SD SE-M CVCAD M R 39.68 4.78 0.44 12.05(Cases) L 40.17 4.91 0.45 12.24 R+L 39.93 4.85 0.45 12.15 F R 38.43 5.39 0.98 14.01 L 40.67 6.47 1.18 15.91 R+L 39.55 5.93 1.08 14.96 M+F R 39.43 4.91 0.40 12.46 L 40.27 5.24 0.43 13.02 R+L 39.85 5.08 0.41 12.74Controls M R 39.33 5.21 0.48 13.26(Normal) L 40.43 5.23 0.48 12.93 R+L 39.88 5.22 0.48 13.10 F R 40.40 5.54 1.01 13.72 L 41.40 5.11 0.93 12.34 R+L 40.90 5.33 0.97 13.03 M+F R 39.54 5.28 0.43 13.36 L 40.63 5.20 0.42 12.81 R+L 40.08 5.24 0.42 13.08


Table 42 shows statistical calculation of ab ridge count in CAD and controls.

There is slight increase in the mean value of ab ridge count in CAD males and

decrease in CAD females and CAD (M+F) as compared to the controls.

There is also decrease in the mean value of ab ridge count in both right

and left hand in CAD as compared to the controls.

Table 43: Test of Significance for a-b Ridge Count for comparison between total

CAD and Control

t- Std T- P RemarkComparison value value valueNMRxCMR 0.542 1.970 0.588 NSNMLxCML 0.397 1.970 0.692 NSNM(R+L)xCM(R+L) 0.098 1.965 0.922 NSNFRxCFR 1.396 2.002 0.168 NSNFLxCFL 0.485 2.002 0.630 NSNF(R+L)xCF(R+L) 1.312 1.980 0.192 NSNTRxCTR 0.187 1.968 0.852 NSNTLxCTL 0.597 1.968 0.551 NSNT(R+L)xCT(R+L) 0.546 1.964 0.585 NS

Table 43 shows t-value for ab ridge count for comparison between total CAD

and controls. There is no statistically significant difference in the mean value

of ab ridge count in CAD males, CAD females and CAD (M+F) when

compared with the controls. Also no statistically significant difference in the

mean value of ab ridge count in both right and left hand in CAD when

compared with the controls.


VII. atd ANGLE

Table 44: Statistical Calculation of atd angle in different Groups of CAD and Controls

Groups RIGHT HAND LEFT HAND MEAN SD SE-M CV MEAN SD SE-M CVControls 39.72 4.1 0.33 10.33 39.85 4.34 0.35 10.9SVD 39.89 4.67 0.64 11.71 40.77 5.01 0.69 12.28DVD 41.07 5.37 0.84 13.08 41.61 5.37 0.84 12.91TVD 41.21 4.75 0.64 11.54 41.61 4.88 0.65 11.74

Table 44 shows statistical calculation of atd angle in different groups of CAD

and controls. There is increase in the mean value of atd angle in all groups of

CAD in both right and left hand as compared to the controls.

There is increase in the mean value of atd angle in left hand in all

groups of CAD as compared to right hand.

Table 45: Test of Significance for atd angle for comparison between different Groups

of CAD and Controls

Comparison RIGHT HAND LEFT HAND with t- Std T- P Remark t- Std T- P RemarkControls value value value value value valueSVD 0.250 1.972 0.803 NS 1.272 1.972 0.205 NSDVD 1.741 1.973 0.083 S 2.182 1.973 0.030 STVD 2.220 1.972 0.027 S 2.502 1.972 0.013 S

Table 45 shows t-value for atd angle for comparison between different groups

of CAD and controls. There is statistically significant difference in the mean

value of atd angle in DVD (P<0.05) and TVD (P<0.05) of both right hand and

left hand when compared with controls.

Table 46: Frequency distribution of atd angle in total CAD and Controls


atd MALE FEMALE angle CAD CONTROL CAD CONTROL

R L T % R L T % R L T % R L T %26-30 0 1 1 0.4 1 1 2 0.8 0 0 0 0.0 0 0 0 0.031-35 13 11 24 10.0 19 16 35 14.6 5 4 9 15.0 5 4 9 15.036-40 54 48 102 42.5 61 62 123 51.3 11 7 18 30.0 12 12 24 40.041-45 37 43 80 33.3 30 34 64 26.7 9 11 20 33.3 10 8 18 30.046-50 11 10 21 8.8 8 5 13 5.4 5 6 11 18.3 2 5 7 11.751-55 3 5 8 3.3 1 1 2 0.8 0 2 2 3.3 1 1 2 3.356-60 2 2 4 1.7 0 1 1 0.4 0 0 0 0.0 0 0 0 0.0

Table 46 shows frequency distribution of atd angle in total CAD and controls.

In CAD males, maximum percentage of atd angle is seen between 36-40

(42.5%) as compared to control males where it is seen between 36-40

(51.3%).

In CAD females, maximum percentage of atd angle is seen between

41-45 (33.3%) as compared to control females where it is seen between 36-

40 (40%).

Table 47: Statistical Calculation for atd angle in total CAD and Controls

Subject Sex Side MEAN SD SE-M CVCAD M R 40.77 5.02 0.46 12.32(Cases) L 41.09 5.01 0.46 12.19 R+L 40.94 5.02 0.46 12.26 F R 40.47 4.49 0.82 11.08 L 42.20 5.18 0.94 12.26 R+L 41.34 4.84 0.88 11.67 M+F R 40.71 4.91 0.40 12.06 L 41.31 5.04 0.41 12.21 R+L 41.01 4.98 0.41 12.14Controls M R 39.61 4.07 0.37 10.27(Normal) L 39.54 4.21 0.38 10.64 R+L 39.58 4.14 0.38 10.46 F R 40.17 4.28 0.78 10.64 L 41.10 4.72 0.86 11.49 R+L 40.64 4.50 0.82 11.07 M+F R 39.72 4.10 0.33 10.33 L 39.85 4.34 0.35 10.90 R+L 39.79 4.22 0.34 10.62

Table 47 shows statistical calculation of atd angle in CAD and controls. There

is increase in the mean value of atd angle in CAD males, CAD females and

CAD (M+F) as compared to the controls.


There is also increase in the mean value of atd angle in both right and

left hand in CAD as compared to the controls.

Table 48: Test of Significance for atd angle for comparison between total CAD and

Controls

t- Std T- P RemarkComparison value value value NMRxCMR 1.983 1.970 0.048 SNMLxCML 2.595 1.970 0.010 SNM(R+L)xCM(R+L) 3.240 1.965 0.001 SNFRxCFR 0.265 2.002 0.792 NSNFLxCFL 0.860 2.002 0.393 NSNF(R+L)xCF(R+L) 0.821 1.980 0.413 NSNTRxCTR 1.895 1.968 0.059 NSNTLxCTL 2.688 1.968 0.008 SNT(R+L)xCT(R+L) 3.252 1.964 0.001 S

Table 48 shows t-value for atd angle for comparison between total CAD and

controls. There is statistically significant difference in the mean value of atd

angle in CAD males (P<0.001), CAD (M+F) (P<0.001) and CAD left hand

(P<0.01) when compared with the controls. There is no statistically significant

difference in atd angle in CAD females.


DISCUSSION:

Dermatoglyphics as a diagnostic tool is now well established in a

number of diseases which have strong hereditary basis. Coronary Artery

Disease being the hereditary background, certain dermatoglyphic variation is

to be expected in it.

The present study is carried out in the department of Anatomy. The

study consists of 150 patients of CAD diagnosed after coronary angiography

and equal numbers of normal healthy individual were included as controls for

comparison. The prints were obtained by “ink method” on the map litho paper

and analysed to find out variations in dermatoglyphic features among CAD

and control group.

The dermatoglyphic patterns are analysed under following heading:


a. Loops

b. Arches

c. Whorls


a. Total Finger Ridge Count (TFRC)

b. Absolute Finger Ridge Count (AFRC)




VI. a b Ridge Count

VII. atd Angle


The observed values in the current study were first subjected to the

test of statistical significance and the findings were then compared with the

available literature of previous workers.

In the present study, there are 120 males and 30 females in both CAD

and control groups. The mean age of male and female is 55.18 years and

53.83 years respectively in CAD as compared to 41.29 years and 43 years

respectively in controls.

The CAD patients in the present study were classified into three groups

as SVD, DVD, TVD depending on the number of vessels involved due to

atherosclerosis, and it is found that 35.3% of the patients have SVD, 27.3%

have DVD and 37.3% have TVD. This finding is similar to Fuster V et al.

(2001)37 and Harsh Mohan (2006)50. Fischer et al. (2005)35 noticed SVD in

23.1%, DVD in 33.1% and TVD in 40.3% cases.


LOOPS:

In the present study, there is significant decrease in the percentage of

loops in SVD (P< 0.001) and TVD (P< 0.01) with slight increase in DVD when

compared to the controls. There is predominance of ulnar loop pattern as

compared to radial loop in both sexes in CAD and control group. The

percentage of loops is decreased in CAD in both sexes and in both hands

with significant decrease in CAD males (P< 0.01), CAD (M+F) (P< 0.001) and

CAD left hand (P<0.01). The frequency of loop is decreased in all digits of


CAD patients in both sexes and in both hands with significant decrease in

index finger (D1) (P<0.05) in males when compared with controls.

Rashad and Mi (1975)100 reported significantly lower frequency of ulnar

loops in myocardial infarction patients. Rashad et al. (1978)101 had observed

less frequency of ulnar loops in MI patients. Anderson MW et al. (1981) 4

found decrease in the loop pattern in MI but not statistically significant

difference when compared with the controls. Bhatt (1996)13 revealed lower

incidence of loops in MI. Dhall et al. (2000)30 observed that the loop pattern

was significantly lower in MI patients as compared to the control group (P<

0.001). Jalali et al. (2002)58 also revealed significant decrease in the

percentage of loops in MI.

Thus the finding of decreased frequency of loops in the present study

coincides with the finding of above workers. However, Shamsadini S et al.

(1997)110 reported significant increase in the frequency of loops in MI patients

(P< 0.001).

Dhall et al. (2000)30 also noticed lower percentage of loops in all the

digits of the patients with statistically significant in right thumb (D1) and left

ring finger (D4). These findings correlated with the present study finding but

not statistically significant.

Significant decreased percentage of loops in SVD and TVD and slight

increase percentage of loops in DVD could not be compared as none of the

workers had classified CAD into SVD, DVD and TVD for dermatoglyphic

study. However, Shamsadini et al. (1997)110 and Jalali et al. (2002)58 had


classified Myocardial Infarction patients into Q-wave MI and non-Q-wave MI.

Jalali et al. (2002)58 noticed that the percentage of loops tended to be greater

in Q-wave MI as compared to non-Q-wave MI. In the present study, the

frequency of loops is higher in DVD as compared to SVD and TVD.

ARCHES:

In the present study, the percentage of arches is decreased in DVD

and TVD but not significant. The percentage of tented arches is almost

doubled as compared to the plain arches in both CAD and control groups. The

percentage of arches is decreased in CAD in both sexes and in both hands

but not significant. The frequency of arches is decreased in all digits of CAD

patients in both sexes (except D1 in males and D4 and D5 in females) and in

both hands (except D3 in left hand) with significant difference in arches in D5

in males (P<0.01) and D1 (P<0.01) and D5 (P<0.05) in females when


Rashad et al. (1978)101 had observed less frequency of tented arches

in MI patients. Anderson MW et al. (1981)4 studied an association of

dermatoglyphic features and MI but found no statistically significant difference

in finger pattern type when compared with the controls. Dhall et al. (2000)30

observed decrease in the frequency of arches in MI patients but not

statistically significant. Jalali et al. (2002)58 found that arch type of fingerprint

was significantly increased roughly two times in MI patients (P<0.0001) as



Thus the finding of decreased frequency of arches in CAD in the

present study is similar to the finding of above workers except Jalali et al

(2002)58 who found two fold increase in the frequency of arch pattern in MI

patients.

Jalali et al. (2002)58 also noticed that the percentage of arches was

increased in all digits of MI patients with significant increase in left thumb

(D1), left index (D2) and left ring finger (D4) (P<0.0001). These findings do not

correlated with the present study finding in which there is slight decrease in

the frequency of arches in all digit of CAD in both hands except D3 of left

hand but not statistically significant. However there is significant decrease in

arches in little finger (D5) in males; and thumb (D1) and little finger (D5) in

females.

Decreased percentage of arches in DVD and TVD could not be

compared as none of the workers had classified CAD into SVD, DVD and

TVD. However, Jalali et al. (2002)58 noticed that the percentage of arch type

was significantly increased in both Q-wave and non-Q-wave MI as compared

to the controls (P<0.0001), but the percentage was higher in non-Q- wave MI

in contrast to Q-wave MI. In the present study, the percentage of arches is

highest in SVD as compared to DVD and TVD.

WHORLS:

In the present study, the percentage of whorls is increased in all group

of CAD with statistically significant in SVD (P< 0.001) and TVD (P< 0.0001)


when compared to the controls. There is predominance of simple whorls as

compared to double loop whorls and other composite whorls in both sexes in

CAD and control group. However, there is significant increase in the

percentage of total composite whorls in CAD (12.6%) as compared to the

controls (8.9%). The percentage of whorls is increased in CAD in both sexes

and in both hands with significant increase in CAD males (P< 0.001), CAD

(M+F) (P< 0.0001) and CAD left hand (P< 0.01). The percentage of whorls is

increased in all digit of CAD in both sexes (except D4 in females) and in both

hands with significant increase in D5 in males (P< 0.01) and D1 and D5 of left

hand (P< 0.05).

Rashad and Mi (1975)100 reported significantly higher frequency of

whorls in myocardial infarction patients. Rashad et al. (1978)101 also reported

significantly higher frequency of true whorls in MI patients. Anderson MW et

al. (1981)4 found increase in the whorl pattern in MI but not statistically

significant difference when compared with the controls. Bhatt (1996)13

revealed higher incidence of whorls in MI. Dhall et al. (2000)30 observed that

the whorl pattern was significantly higher in MI patients as compared to the

control group (P< 0.001). Jalali et al. (2002)58 also revealed slight increase in

the percentage of whorls in MI but not statistically significant.

Thus the finding of increased frequency of whorls in the present study

is similar with the finding of above workers.

Dhall et al. (2000)30 also noticed higher percentage of whorls in all the

digits of the patients with statistically significant in right thumb (D1), right little


finger (D5) and left ring finger (D4). These findings correlated with the present

study finding with significant increase in D1 and D5 of left hand.

Increased percentage of whorls in all groups of CAD could not be

compared as none of the workers had classified CAD into SVD, DVD and

TVD. However, Jalali et al. (2002)58 observed slight increase in the

percentage of whorls in both Q and non-Q wave MI patients but the

percentage of whorls was increased in non-Q-wave MI in contrast to Q-wave

MI. in the present study, the percentage of whorls is highest in TVD in

contrast to SVD and DVD.


Total Finger Ridge Count (TFRC): In the present study there is increase in

the mean value of TFRC in all groups of CAD as compared to the controls but

not statistically significant.

There is increase in the mean value of TFRC in CAD males, CAD

females and CAD (M+F) when compared to the controls but not statistically

significant.

Absolute Finger Ridge Count (AFRC): In the present study there is increase

in the mean value of AFRC in all groups of CAD as compared to the controls

with statistically significant in TVD (P<0.05).

There is also increase in the mean value of AFRC in CAD males, CAD

females and CAD (M+F) when compared with the controls but not statistically

significant.


Rashad and Mi (1975)100 observed significant increase in TFRC and

AFRC in myocardial infarction patients. Rashad et al. (1978)101 also reported

significant increase in TFRC and AFRC in MI patients. Total and Absolute

ridge count were significantly higher (P<0.05) in all digits in favour of MI

patients. Anderson MW et al. (1981)4 observed no statistically significant

increase in TFRC and AFRC in MI patients.

Thus the finding of increased mean value of TFRC and AFRC in CAD

in the present study is similar with the finding of above workers.


In the present study, palmar patterns are predominantly seen in

hypothenar area followed by ID4 and ID3 area in all groups of CAD and

controls. In SVD, there is decrease in the percentage of true palmar pattern in

all areas except hypothenar and ID1 area with statistical significant in ID3

area (P<0.05). In DVD, there is decrease in the percentage of true palmar

pattern in all areas except hypothenar and ID2 area with statistical significant

in thenar area (P<0.05). In TVD, there is decrease in the percentage of true

palmar pattern in all areas except ID1 and ID2 area but not statistically

significant in any areas.

Also the frequency of total palmar pattern in CAD is decreased in both

sexes and both sides as compared to the controls. There is decrease in the

frequency of palmar pattern in all areas except ID2 area in CAD males;

hypothenar area in CAD females; hypothenar, ID1, ID2 area in CAD (M+F);


hypothenar, ID1, ID2, ID4 in right hand; and ID2 area in left hand with

significant decrease in palmar pattern in thenar area in CAD females

(P<0.05), ID3 area in CAD (M+F) and CAD right hand (P<0.05) and ID4 area

in CAD left hand (P<0.05)

No previous workers has carried out the study on palmar pattern in

CAD, hence the present study findings could not be compared. However,

Takashina et al. (1966) 116 observed significant increase in the loop pattern in

hypothenar area in acquired heart disease (33%) as compared to the

congenital heart disease (21%).


In the present study, there is decrease in the percentage of axial triradii

near wrist (t) with increase in the percentage of t’, tt”, t’+tt’ and Distal

Displacement of Axial triradii (DDA) position in both SVD and TVD but not

statistically significant when compared with the controls.

Similarly, there is decrease in the frequency of axial triradii near wrist

(t) with increase in the frequency of t’, tt”, t’+tt’ and Distal Displacement of

Axial triradii (DDA) position in CAD in both sexes and in both hands but not

statistically significant when compared with the controls.

No study has been carried out on position of axial Triradii in CAD,

hence the present study finding could not be compared. However, Takashina

et al. (1966)116 noted significantly greater frequency of distal displacement (t’,


t” and other position) of axial Triradii in patients with congenital heart disease

(64%) as compared to the acquired heart disease (17%).


In the present study, there is increase in the percentage of ‘4’ and ‘7’

palmar Triradii in SVD; ‘4’ and ‘5’ palmar triradii in DVD and ‘4’, ‘5’ and ‘7’

palmar triradii in TVD with significant increase in ‘4’ palmar triradii (P<0.0001)

and ‘7’ palmar triradii (P<0.01) in SVD; and ‘5’ palmar triradii in DVD (P<0.01).

Also, there is decrease in the percentage of ‘5’ and ‘6’ palmar triradii in SVD

and ‘6’ palmar triradii in DVD and TVD with significant decrease in ‘6’ palmar

triradii in DVD (P<0.001) and TVD (P<0.01).

Similarly in the total cases, there is increase in the frequency of ‘5’

palmar triradii in CAD females and ‘4’, ‘5’ and ‘7’ palmar triradii in CAD males,

CAD (M+F) and in both hands with significant increase in ‘4’ palmar triradii in

CAD males (P<0.01), CAD (M+F) (P<0.01) and CAD right hand (P<0.05); and

5 palmar triradii in CAD females (P<0.05). Also there is significant decrease in

the frequency of ‘6’ palmar triradii in CAD males (P<0.01), CAD females

(P<0.05), CAD (M+F) (P<0.001), CAD right hand (P<0.05) and CAD left hand

(P<0.01) as compared to the controls.

No study has been carried out previously on number of palmar Triradii

in CAD, hence present study findings could not be compared.


VI. ab Ridge Count

In the present study, the mean value of ab ridge count in different

groups of CAD is slightly lesser in both right and left hand as compared to the

controls but not significant.

There is slight increase in the mean value of ab ridge count in CAD

males and decrease in CAD females, CAD (M+F) and in both hands as

compared to the controls but not statistically significant.

This present study findings could not be compared as no previous

study has been carried out on ab ridge count in CAD.

VII. atd Angle

In the present study, the mean value of atd angle in all groups of CAD

is increased in both right and left hand as compared to the controls with

significant increase in DVD (P<0.05) and TVD (P<0.05) in both hands.

There is increase in the mean value of atd angle in both sexes and in

both hands with significant increase in CAD males (P<0.001), CAD (M+F)

(P<0.001) and CAD left hand (P<0.01).

No study has been carried out on atd angle in CAD, hence present study

findings could not be compared.


SUMMARY AND CONCLUSIONS:

The present study is undertaken with an aim to evaluate

dermatoglyphic features in CAD. The study consists of 150 patients of CAD

diagnosed by coronary angiography and 150 normal healthy individuals as

controls. There were 120 males and 30 females in each group. The CAD

cases were again classified into 3 groups as SVD, DVD and TVD.

Dermatoglyphic prints were taken by “Ink Method” described by

Cummins and Midlo (1961)26 and further subjected to analysis to find variations

in the dermatoglyphic features among CAD patients and control group.

1. Loops are significantly decreased in SVD (P<0.001) and TVD


2. Loops are decreased in all digits of CAD in both sexes and both

hands with significant decreased in thumb (D1) in males (P<0.05).

3. Loops are decreased in CAD in both sexes and both hands with

significant decrease in CAD males (P<0.01), CAD (M+F) (P<0.001)

and CAD left hand (P<0.01).

4. Arches are decreased in DVD and TVD but not significant.

5. Arches are decreased in all digits of CAD in both sexes (except D1 in

males and D4 and D5 in females) and both hands (except D3 of left

hand) with significant decreased in little finger in males (P<0.01) and


thumb in females (P<0.01) and increased in little finger in females

(P<0.05).

6. Arches are decreased in CAD in both sexes and both hands but not

significant.

7. Whorls are significantly increased in SVD (P<0.001) and TVD

(P<0.0001).

8. Whorls are increased in all digits of CAD in both sexes and both

hands with significant increase in little finger (D1) in male (P<0.01)

and thumb (D1) and little finger (D5) of left hand (P<0.05).

9. Whorls are increased in CAD in both sexes and both hands with

significant increase in CAD males (P<0.001), CAD (M+F) (P<0.0001)

and CAD left hand (P<0.01).

10. Mean value of TFRC and AFRC in all groups of CAD is increased

with significant increase in the AFRC in TVD (P<0.05).

11. Mean value of TFRC and AFRC is increased in CAD in both sexes as

compared to the controls but not significant.

12. The true palmar pattern is significantly decreased in ID3 area in SVD

(P<0.05) and thenar area in DVD (P<0.05).

13. The true palmar pattern is significantly decreased in thenar area in

CAD females (P<0.05), ID3 area in CAD (M+F) (P<0.05) and CAD

right hand (P<0.05), and ID4 area in CAD left hand (P<0.05).

14. The percentage of axial triradii near wrist (t) is decreased with

increase in distal displacement (t’, tt”, t’+tt’) of axial triradii in both


SVD, TVD and in CAD in both sexes and both hands but not

significant.

15. There is significant increase in frequency of ‘4’ palmar triradii

(P<0.0001) and ‘7’ palmar triradii (P<0.01) in SVD; and ‘5’ palmar

triradii in DVD (P<0.01) with significant decrease in frequency of ‘6’

palmar triradii in DVD (P<0.001) and TVD (P<0.01).

16. There is significant increase in ‘4’ palmar triradii in CAD males

(P<0.01), CAD (M+F) (P<0.01) and CAD right hand (P<0.05); and ‘5’

palmar triradii in CAD females (P<0.05) with significant decrease in

‘6’ palmar triradii in CAD males (P<0.01), CAD females (P<0.05),

CAD (M+F) (P<0.001), CAD right hand (P<0.05) and CAD left hand


17. Mean value of ab ridge count in different groups of CAD is slightly

decreased in both hands, and in CAD females and CAD (M+F) with

slight increase in mean value in CAD males.

18. Mean value of atd angle is significantly increased in DVD (P<0.05)

and TVD (P<0.05) in both hands.

19. Mean value of atd angle is significantly increased in CAD males

(P<0.001), CAD (M+F) (P<0.001) and CAD left hand (P<0.01).

Conclusions:

In the present study, it is concluded that:

1. There is significant decrease in loops with corresponding increase in

whorls in SVD and TVD.


2. There is decrease in loops and increase in whorls in all digits of CAD

in both sexes and both hands.

3. There is significant decrease in loops in thumb in males with

significant increase in whorls in little finger in males, and thumb and

little finger in left hand in CAD patients.

4. There is significant decrease in arches in little finger in males and

thumb in females with significant increase in arches in little finger in

females in CAD patients.

5. There is significant decrease in loops with corresponding increase in

whorls in CAD males, CAD (M+F) and CAD left hand as compared to

the controls.

6. No significant decrease in the arches in DVD, TVD and in CAD in

both sexes and both hands.

7. There is increase in the mean value of TFRC and AFRC in SVD,

DVD, TVD and in CAD in both sexes with significant increase in

AFRC in TVD.

8. There is significant decrease in true palmar pattern in thenar area in

DVD and CAD females; ID3 area in SVD, CAD (M+F) and CAD right

hand; and ID4 area in CAD left hand as compared to the controls.

9. There is decrease in the percentage of axial triradii near wrist (t) with

increase in distal displacement (t’, tt”, t’+tt’) of axial triradii in both

SVD, TVD and in CAD in both sexes and both hands but not

significant.


10. There is significant increase in frequency of ‘4’ palmar triradii and ‘7’

palmar triradii in SVD; and ‘5’ palmar triradii in DVD with significant

decrease in frequency of ‘6’ palmar triradii in DVD and TVD.

11. There is significant increase in ‘4’ palmar triradii in CAD males, CAD

(M+F) and CAD right hand; and ‘5’ palmar triradii in CAD females

with significant decrease in ‘6’ palmar triradii in CAD in both sexes

and both sides as compared to the controls.

12. No significant differences in the mean value of ab ridge count in CAD

in either sexes or in any groups of CAD.

13. There is significant increase in the mean value of atd angle is in DVD

and TVD in both hands and in CAD males, CAD (M+F) and CAD left

hand.

Thus from the present study, it appears that there do exists a variation

in the dermatoglyphic patterns in CAD and its groups with an advantage of

being very simple and economical ‘ink’ method. Moreover the materials

required for the dermatoglyphic procedure are easily available and portable.

As the specific features of dermatoglyphic patterns are present in the CAD

and its groups, it can be use for mass screening program for prevention of

CAD.


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ANNEXURE:ABBREVIATIONS USED IN MASTER SHEET

A : Arches

A.C : Associated Conditions

A.F : Angiography Findings

a-b RC : ab ridge count

AFRC : Absolute Finger Ridge Count

Ap : Plain Arch

A-r : Arch Radial

At : Tented Arch

atd ang : atd angle

Au : Arch Ulnar

D1 : First Digit/ Thumb

D2 : Second Digit/ Index Finger

D3 : Third Digit/ Middle Finger

D4 : Fourth Digit/ Ring Finger

D5 : Fifth Digit/ Little Finger

DVD : Double Vessel Disease

F : Female

Hypo : Hypothenar

ID1 : First Inter-digital area

ID2 : Second Inter-digital area

ID3 : Third Inter-digital area

ID4 : Fourth Inter-digital area

L : Loop

L-c : Loop Carpal/ Proximal

L-d : Loop Distal

L-r : Radial Loop

Lu : Ulnar Loop

M : Male

Name : Initials of individuals

NOPT : Total Number of Palmar Triradii

O : Open


POAT : Position of Axial Triradii

Sr. No. : Number

SVD : Single Vessel Disease

t = Triradius near wrist crease

t" = Triradius near centre of palm

t' = Triradius between t and t"

TFRC : Total Finger Ridge Count

Th : Thenar

TVD : Triple/ Multi Vessel Disease

V : Vestige

W : Whorls

Wacc : Whorl Accidental

Wc : Whorl Concentric

Wcp : Central Pocket Whorl

Wlp : Lateral Pocket Whorl

Wmix : Whorl Mixed

Ws : Whorl Spiral

Wtl : Twin Loop Whorl


MASTER SHEET OF DERMATOGLYPHICS IN CONTROL SUBJECTS

MASTER SHEET OF DERMATOGLYPHICS IN PATIENTS (CAD)


PATIENT’S INFORMATION SHEETTitle of Research Project: Study of Palmer Dermatoglyphics in Coronary Artery Disease.Name of the Investigator: Dr. Address: P.G student

Dept. of Anatomy

The aim of this research project is to study the palmer dermatoglyphic pattern in the patients of CAD & compare it with the dermatoglyphic pattern of the non-affected general population.

The Method that will be used is ‘Ink Method’.

Palmer & finger prints will be taken on white paper by ink method.

Biological samples are not required for this project. Expected duration required to take palmer prints by this method is about 10-15 minutes.

By participating in the study there is no risk to the patients. All these records will be kept confidential.

Free treatment for research related injury by the investigator/ institution will NOT be provided.

The patient can withdraw from research at any time without penalty.

INFORMATION CONSENT FORM (ICF)(CONFIDENTIAL)

Title of Research Project: Study of Palmer Dermatoglyphics in Coronary Artery Disease.

I_________________________________ resident of _________________________________________________ aged ____ years, excercising my free will/choice, without any pressure/lure of incentive in any form hereby give my consent.

I acknowledge the receipt of “ Patient’s Information Sheet” and also the doctors have informed me about this research project suitably & sufficiently to my satisfaction. I am ready do give my palmer & finger prints by using ink. I shall co-operate with doctors & paramedical staff on all participation in this study. I shall not be given any reimbursment or compensation. I have been informed of my right to opt out of this research project at any time without giving any reason for doing so.

I hereby record my consent for participation in the research project.

1. _________________________ _____________ _________ _________ Patient’s Name Signature/Thumb Date Time

Print2. __________________________ _____________ ________ _________ Witness Name Sign Date Time3. __________________________ _____________ ________ _________ Investigator’s Name Sign Date Time


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CERTIFICATE


This is to certify that the work contained in this thesis entitled “Study

of Palmar Dermatoglyphics in Coronary Artery Disease” has been

carried out by Dr. Hemlata Dhanraj Chimne in the Department of

Anatomy, NKP Salve Institute of Medical Sciences and Research Centre,

Nagpur, under my direct guidance and supervision as required by the

Maharashtra University of Health Sciences, Nashik for award of degree of MD

in Anatomy.

I have checked her work on the subject from time to time. I am satisfied

regarding the authenticity of her observation, materials and work in this

dissertation and it conforms to the standards of MUHS, Nashik.

Date:07/12/09

Place: Nagpur

Dr. D.D. KsheersagarMS (Anatomy)

(PG GUIDE)

Professor and Head Department of Anatomy,

NKP SIMS & RC,

Nagpur.

CERTIFICATE


This is to certify that the work contained in this thesis entitled “Study

of Palmar Dermatoglyphics in Coronary Artery Disease” has been

carried out by Dr. Hemlata Dhanraj Chimne (Candidate) under the direct

guidance of Dr. D. D. Ksheersagar (Guide), Professor and Head, Department

of Anatomy at NKP Salve Institute of Medical Sciences and Research Centre,

Nagpur as partial fulfillment of regulations for the award of the degree of MD

in Anatomy.

We have a great pleasure in forwarding it to Maharashtra University of

Health Sciences, Nashik.

Date:07/12/09

Place: Nagpur

Dr. D.D. Ksheersagar Dr. S. Dasgupta MS (Anatomy) MS (Surgery)

Professor and Head Dean,

Department of Anatomy, NKP SIMS & RC

NKP SIMS and RC, Nagpur Nagpur.

College Seal

DECLARATION


I hereby declare that the dissertation entitled “Study of Palmar

Dermatoglyphics in Coronary Artery Disease” has been prepared by me under

the direct guidance and supervision of Dr. D. D. Ksheersagar (Guide), in

partial fulfilment of regulations of Maharashtra University of Health Sciences,

Nashik for the award of the degree of MD in Anatomy (Subject) and it has not

been submitted previously for the award of any diploma or degree from the

university as per my best knowledge and belief.

Date:07/12/09

Place: Nagpur

Dr. Hemlata Dhanraj Chimne

(Candidate)


ACKNOWLEDGEMENT

Having surmounted all the difficulties and reaching the share of

completing the work of this dissertation, I am feeling the limitation of language

and words while acknowledging thanks to all those who helped me in voyage.

It is with great pleasure and deep sense of gratitude that I acknowledge

my debt to my guide Dr. D.D. Ksheersagar, Professor and head, Department

of Anatomy, NKP Salve Institute of Medical Sciences and Research Centre,

Nagpur, for his affectionate guidance, meticulous attention, keen interest with

which he has provided me the suggestions, knowledge and support to

construct this work.

I am extremely thankful to Dr. S.D. Nagpure and Dr. M.R. Shende,

Professors, Department of Anatomy, NKP Salve Institute of Medical Sciences

and Research Centre, Nagpur, for their remarkable insight and expert

guidance.

I am thankful to Dr. Dasgupta, Dean and Dr. Doifode, Director PG Cell,

NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, for

permitting me to carry out this work in this institute.

I express my sincere gratitude to Dr. Jaspal Singh Arneja, Director

Arneja Heart Institute; Dr. Uday B. Mahorkar, Director Awanti Heart Institute;

and Dr. Harshawardhan Mardikar, Incharge, Spandan Heart Institute and


Research Centre, Nagpur for permitting me to take palmar prints of the

patients in their hospitals/ institute.

I owe my obligation to Dr. Arun P. Kasote, Associate Professor,

Government Medical College, Nagpur for his invaluable support, guidance

and encouragement during this work.

I am very thankful to Dr. Deepali P. Onkar, Dr Rajesh N. Dehankar,

Dr. Manjusha K. Tabhane for their whole hearted support and guidance.

I am also thankful to Dr. S.V. Sathe, Dr. S.M. Walulkar, Dr. Mrs. R.K.

Deshpande, Dr. M.D. Huddar, Dr. Mrs. S.S. Mahajan for their kind suggestion

during this work.

I express my sincere thanks to Dr. A.C. Fulse, Dr. S.H. Lade, Dr. U. G.

Shrivastav, Dr. S. Durge, and all the staff members of department for their

cooperation during this work.

I am also thankful to Mr. Dashrath Basannar, Statistician for helping in

statistical analysis.

My heartful gratitude to my husband without whose understanding and

support it would have been impossible to complete this work. I am specially

obligated and thankful to my family members and my daughter Vidhi for

incalculable cooperation during the whole work.

Last but not the least, I would like to thank all my patients and subjects

who were the backbone of this study without them the study would not have

been possible.

Dr. Hemlata Dhanraj Chimne