{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T02:20:57Z","timestamp":1790734857721,"version":"4.1.0"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,10,14]],"date-time":"2021-10-14T00:00:00Z","timestamp":1634169600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"James Nutter Family and Maria Long Family Fellowship in Cardiovascular Research grant"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>The current gold standard comprehensive assessment of coronary microvascular dysfunction (CMD) is through a limited-access invasive catheterization lab procedure. We aimed to develop a point-of-care tool to assist clinical guidance in patients presenting with chest pain and\/or an abnormal cardiac functional stress test and with non-obstructive coronary artery disease (NOCAD).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>This study included 1893 NOCAD patients (&amp;lt;50% angiographic stenosis) who underwent CMD evaluation as well as an electrocardiogram (ECG) up to 1-year prior. Endothelial-independent CMD was defined by coronary flow reserve (CFR) \u22642.5 in response to intracoronary adenosine. Endothelial-dependent CMD was defined by a maximal percent increase in coronary blood flow (%\u0394CBF) \u226450% in response to intracoronary acetylcholine infusion. We trained algorithms to distinguish between the following outcomes: CFR \u22642.5, %\u0394CBF \u226450, and the combination of both. Two classes of algorithms were trained, one depending on ECG waveforms as input, and another using tabular clinical data. Mean age was 51\u2009\u00b1\u200912\u2009years and 66% were females (n\u2009=\u20091257). Area under the curve values ranged from 0.49 to 0.67 for all the outcomes. The best performance in our analysis was for the outcome CFR \u22642.5 with clinical variables. Area under the curve and accuracy were 0.67% and 60%. When decreasing the threshold of positivity, sensitivity and negative predictive value increased to 92% and 90%, respectively, while specificity and positive predictive value decreased to 25% and 29%, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>An artificial intelligence-enabled algorithm may be able to assist clinical guidance by ruling out CMD in patients presenting with chest pain and\/or an abnormal functional stress test. This algorithm needs to be prospectively validated in different cohorts.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjdh\/ztab084","type":"journal-article","created":{"date-parts":[[2021,10,18]],"date-time":"2021-10-18T11:51:38Z","timestamp":1634557898000},"page":"597-605","source":"Crossref","is-referenced-by-count":11,"title":["Machine learning aids clinical decision-making in patients presenting with angina and non-obstructive coronary artery disease"],"prefix":"10.1093","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9669-8009","authenticated-orcid":false,"given":"Ali","family":"Ahmad","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , 200 First Street SW, Rochester, MN 55902, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Shelly-Cohen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , 200 First Street SW, Rochester, MN 55902, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6443-2345","authenticated-orcid":false,"given":"Michel T","family":"Corban","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , 200 First Street SW, Rochester, MN 55902, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis H","family":"Murphree Jr","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , 200 First Street SW, Rochester, MN 55902, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4681-2798","authenticated-orcid":false,"given":"Takumi","family":"Toya","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , 200 First Street SW, Rochester, MN 55902, USA"},{"name":"Department of Medicine, Division of Cardiology, National Defense Medical College , Tokorozawa, 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