title: The assessment of ischaemic burden: validation of a functional jeopardy score against cardiovascular magnetic resonance perfusion imaging.
abstract: OBJECTIVE
  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.
  
  
  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 % (APP70and 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.
authors.affiliation: Cardiology Department, Papworth Hospital NHS trust, Papworth Everard, Cambridgeshire, UK. shaziathussain@icloud.com.
authors.forename: Shazia T
authors.initials: ST
authors.lastname: Hussain
authors.affiliation: Portsmouth Hospitals NHS Trust, Portsmouth, UK.
authors.forename: Geraint
authors.initials: G
authors.lastname: Morton
authors.affiliation: 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.
authors.forename: Kalpa
authors.initials: K
authors.lastname: De Silva
authors.affiliation: 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.
authors.forename: Roy
authors.initials: R
authors.lastname: Jogiya
authors.affiliation: Department of Cardiology and Pneumonology, Georg-August-University Gottingen and German Centre for Cardiovascular Research (DZHK, Partner Site Gottingen), Gottingen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuster
authors.affiliation: Luzerner Kantonsspital, 6000, Luzern 16, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Paul
authors.affiliation: 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.
authors.forename: Divaka
authors.initials: D
authors.lastname: Perera
authors.affiliation: DZHK Centre for Cardiovascular Imaging, University Hospital, Frankfurt/Main, Germany.
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D003326:Coronary Circulation / Q000502:physiology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index
keywords: Coronary artery disease; Fractional flow reserve; Ischemia; Non-invasive imaging; QCA