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The assessment of ischaemic burden: validation of a functional jeopardy score against cardiovascular magnetic resonance perfusion imaging

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Abstract

Aims

This study assesses the relationship between classical anatomical jeopardy scores, functional jeopardy scores (combined anatomical and haemodynamic data), and the extent of ischaemia identified on cardiovascular magnetic resonance (CMR) perfusion imaging.

Methods and results

In 42 patients with stable angina and suspected coronary artery disease (CAD), CMR perfusion imaging was performed. Fractional Flow Reserve (FFR) was measured in vessels with ≥50 % stenosis. The APPROACH and BCIS jeopardy scores were calculated based on QCA results with both a 70 % (APP70 and BCIS70) and a 50 % stenosis (APP50, and BCIS50) used as the threshold for significance, as well as after integration of FFR and compared with the extent of ischaemia identified on CMR. The correlation between the extent of ischaemia measured by CMR and the anatomical jeopardy scores was moderate (APPROACH: r = 0.58; BCIS: r = 0.48, p = 0.001). Integrating physiological information improved this significantly to r = 0.82, p = 0.0001 for APPROACH and r = 0.82, p = 0.0001 for BCIS scores (z-statistic = −2.04, p = 0.04; z-statistic = −2.63, p = 0.009). In relation to CMR, the APPROACH and BCIS scores overestimated the volume of ischaemic myocardium by 29.2 and 25.2 %, respectively, which was reduced to 12.8 and 12 % after integrating functional data.

Conclusions

Anatomical and functional jeopardy scores overestimate ischaemic burden when compared to CMR. Integrating physiological information from FFR to generate a functional score improves ischaemic burden estimation.

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Acknowledgments

The authors acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust.

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Authors and Affiliations

  1. Cardiology Department, Papworth Hospital NHS trust, Papworth Everard, Cambridgeshire, UK

    Shazia T. Hussain

  2. Portsmouth Hospitals NHS Trust, Portsmouth, UK

    Geraint Morton

  3. Cardiovascular Division, King’s College London BHF Centre of Excellence, NIHR Biomedical Research Centre at Guy’s and St. Thomas’ NHS Foundation Trust, The Rayne Institute, London, UK

    Kalpa De Silva & Divaka Perera

  4. Division of Imaging Sciences, King’s College London BHF Centre of Excellence, NIHR Biomedical Research Centre and Welcome Trust and EPSRC Medical Engineering Centre at Guy’s and St. Thomas’ NHS Foundation Trust, The Rayne Institute, London, UK

    Roy Jogiya

  5. Department of Cardiology and Pneumonology, Georg-August-University Gottingen and German Centre for Cardiovascular Research (DZHK, Partner Site Gottingen), Gottingen, Germany

    Andreas Schuster

  6. Luzerner Kantonsspital, 6000, Luzern 16, Switzerland

    Matthias Paul

  7. DZHK Centre for Cardiovascular Imaging, University Hospital, Frankfurt/Main, Germany

    Eike Nagel

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  1. Shazia T. Hussain
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  2. Geraint Morton
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Correspondence to Shazia T. Hussain.

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Conflict of interest

Prof. Nagel received a significant grant support from Bayer Schering Pharma and Philips Healthcare. The other authors declare that they have no competing interests.

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Hussain, S.T., Morton, G., De Silva, K. et al. The assessment of ischaemic burden: validation of a functional jeopardy score against cardiovascular magnetic resonance perfusion imaging. Clin Res Cardiol 106, 259–270 (2017). https://doi.org/10.1007/s00392-016-1047-0

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  • DOI: https://doi.org/10.1007/s00392-016-1047-0

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