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Published on: February 16, 2016
Validation of the BCIS-1 myocardial jeopardy score using cardiac magnetic resonance perfusion imaging
Geraint D J Morton1, Kalpa De Silva, Masaki Ishida
1Division of Imaging Sciences, King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre, The Rayne Institute, London, UK. geraint.morton@kcl.ac.uk
Insights
The angiographic BCIS-1 Myocardial Jeopardy Score (BCIS-JS) effectively estimates coronary artery disease (CAD) extent. A score of 6 or higher accurately predicts significant myocardial ischaemic burden, aiding clinical practice.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Accuracy
Background:
- Coronary artery disease (CAD) assessment is crucial for patient management.
- The angiographic BCIS-1 Myocardial Jeopardy Score (BCIS-JS) offers a semi-quantitative method to estimate CAD extent.
- Validation of BCIS-JS against functional ischaemic burden is needed.
Purpose of the Study:
- To validate the BCIS-JS by assessing its correlation with myocardial ischaemic burden.
- To evaluate the accuracy of BCIS-JS in predicting a prognostically significant ischaemic threshold.
Main Methods:
- Seventy-five patients with suspected CAD underwent coronary angiography and high-resolution CMR perfusion imaging.
- BCIS-JS was calculated and correlated with measured myocardial ischaemic burden.
- Receiver Operating Characteristic (ROC) curve analysis was used to determine predictive accuracy.
Main Results:
- A strong correlation was observed between BCIS-JS and myocardial ischaemic burden (r=0.75, P<0.0001).
- BCIS-JS demonstrated good accuracy in detecting ≥12% myocardial ischaemic burden (AUC=0.87).
- A BCIS-JS threshold of ≥6 predicted ≥12% ischaemic burden with 91% specificity and 68% sensitivity.
Conclusions:
- The BCIS-JS correlates well with myocardial ischaemic burden, confirming its functional relevance.
- A BCIS-JS ≥6 is a specific predictor of the prognostically important 12% ischaemic threshold.
- BCIS-JS is a valuable tool for classifying CAD burden in clinical trials and practice.
Abstract:
The recently described angiographic BCIS-1 Myocardial Jeopardy Score (BCIS-JS) provides a semi-quantitative estimate of the extent of coronary artery disease (CAD). It is simple to use and applicable to all patients including those with bypass grafts. Our objective was to validate the BCIS-JS by evaluating its correlation with myocardial ischaemic burden and its accuracy at predicting a prognostic ischaemic threshold. Seventy-five patients with angina and known or suspected CAD referred for coronary angiography prospectively underwent high-resolution CMR perfusion imaging. There was good correlation between the BCIS-JS and myocardial ischaemic burden: r = 0·75, P<0·0001. Area under the ROC curve for BCIS-JS to detect ≥12% myocardial ischaemic burden was 0·87 (95% CI 0·78-0·96). BCIS-JS ≥6 predicted ≥12% myocardial ischaemic burden with a sensitivity of 68% and a specificity of 91%. The BCIS-JS correlates well with myocardial ischaemic burden. A BCIS-JS ≥6 predicts the prognostically important ischaemic threshold of 12% with high specificity. These findings demonstrate that the BCIS-JS has functional relevance and support its utility for classification of CAD burden in clinical trials and in clinical practice.
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