- Oral presentation
- Open Access
The assessment of ischaemic burden: validation of a "functional" jeopardy score against cardiovascular magnetic resonance
© Hussain et al; licensee BioMed Central Ltd. 2013
- Published: 30 January 2013
- Cardiovascular Magnetic Resonance
- Fractional Flow Reserve
- Bland Altman Analysis
- Luminal Stenosis
- British Heart Foundation
Due to the increasing emphasis on guiding patient management and revascularisation based on the extent rather than just the presence of ischaemia it is important to understand the relationship between parameters obtained in the catheter laboratory, such as luminal coronary artery stenosis, fractional flow reserve (FFR) and the extent of the ischaemic burden. Classic jeopardy scores estimate the area of myocardium at risk based on luminal stenosis severity without integrating their haemodynamic significance, whereas FFR assesses the impact of a stenosis on flow but is not influenced by the volume of subtended myocardium. Incorporating FFR measurements to a jeopardy score to produce a "functional jeopardy score" may provide a rapid method in the catheterisation laboratory to estimate ischaemic burden. The objective of this study is to assess the relationship between classical anatomical jeopardy scores, functional jeopardy scores (based on the combination of anatomical and haemodynamic data) and the extent of ischaemia identified on cardiovascular magnetic resonance (CMR) perfusion imaging.
39 patients with angina and known or suspected coronary artery disease (CAD) referred for coronary angiography prospectively underwent high-resolution CMR perfusion imaging and coronary angiography. Fractional Flow Reserve (FFR) was measured in all vessels with a stenosis of >50%. The APPROACH and BCIS-1 jeopardy scores were calculated based purely on angiographic anatomy using a cut off of both 50% (APP50 and BCIS50) and 70% (APP70 and BCIS70) as well as after integration of FFR (APPFFR and BCISFFR) and compared with the extent of ischaemia identified on CMR perfusion imaging.
Mean values of angiographic scores and correlation with CMR
Mean result (SD)
Correlation with CMR (r value
Correlation with CMR (r value
Anatomical and functional jeopardy scores overestimate the extent of ischaemia, when compared to CMR. Integrating physiological information from FFR to angiographic lesion characterization to generate a functional jeopardy score improves the estimation of ischaemic burden in the catheterization laboratory.
This work was supported by a European Union Grant (Grant number 224495 to GM, EN); the British Heart Foundation (Research Excellence Award RE/08/003 and FS/10/029/28253 to AS, DP, EN); the Biomedical Research Centre (grant number BRC-CTF 196 to AS, DP, EN) and the Wellcome Trust and EPSRC (grant number WT 088641/Z/09/Z to AC, EN).
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.