{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T07:03:35Z","timestamp":1789715015060,"version":"4.0.1"},"reference-count":58,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,5,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Coronary flow reserve reflects microvascular function, whereas filling pressure indicates myocardial hemodynamic burden. In angina with nonobstructive coronary arteries, abnormalities in either could contribute to a supply\u2013demand mismatch; however, their combined prognostic significance remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Patients with angina with nonobstructive coronary arteries\u00a0who underwent invasive coronary reactivity tests were studied retrospectively. Coronary microvascular dysfunction (CMD) was coronary flow reserve &lt;2.5. An artificial intelligence\u2013enabled ECG marker of elevated filling pressure (AIEFP) was applied as a scalable prognostic marker of myocardial hemodynamic stress. Associations with major adverse cardiovascular events were evaluated using Cox regression and propensity score overlap weighting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Among 1957 patients with angina with nonobstructive coronary arteries (median age, 51.8\u2009years; 67.2% women), CMD+ was identified in 26.4% and AIEFP+ in 6.6%. Over 8\u2009years, 204 patients (10.4%) experienced major adverse cardiovascular events. In nested models, both CMD (hazard ratio [HR]=1.42 [95% CI=1.13\u20131.78];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.002) and AIEFP (HR=2.28 [95% CI=1.67\u20133.11];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) remained associated with major adverse cardiovascular events after adjustment. Adding AIEFP to the base model\u00a0improved model fitness (\u0394\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      =23.65,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001; \u0394Akaike Information Criterion=\u221221.7) and modestly improved discrimination (\u0394Harrell concordance index=0.02,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.02). In a 4\u2010group model, adjusted risks increased in a graded manner. Overlap\u2010weighted analysis after covariate balance demonstrated distinct temporal risk trajectories: CMD+\/AIEFP+ had the highest 1\u2010year risk (12.7%), and AIEFP+ had the highest cumulative 8\u2010year risk (57% in CMD\u2212 and 51.8% in CMD+).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">CMD and AIEFP provide complementary prognostic information, with AIEFP remaining significantly associated with outcomes after multivariable adjustment. A dual\u2010axis framework integrating myocardial hemodynamic stress (AIEFP) and microvascular function (coronary flow reserve) may enhance risk stratification and enable identification of clinically distinct angina with nonobstructive coronary arteries phenotypes with divergent trajectories.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.047946","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T09:15:15Z","timestamp":1778058915000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Incremental Prognostic Power of Coronary Flow Reserve and Artificial Intelligence\u2013Enabled ECG\u2013Derived Filling Pressure in Angina With Nonobstructive Coronary Arteries"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4511-7659","authenticated-orcid":false,"given":"Parvin","family":"Kalhor","sequence":"first","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9080-2183","authenticated-orcid":false,"given":"Matteo","family":"Manzato","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0705-9721","authenticated-orcid":false,"given":"Elias","family":"Hellou","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Nogami","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4601-0434","authenticated-orcid":false,"given":"Valentina","family":"Nardi","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9375-0596","authenticated-orcid":false,"given":"Barry A.","family":"Borlaug","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3271-3887","authenticated-orcid":false,"given":"Lilach O.","family":"Lerman","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9446-5313","authenticated-orcid":false,"given":"Amir","family":"Lerman","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab775"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.11.036"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx721"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr331"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2023.11.039"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-023-02948-1"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae177"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa503"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvaa003"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.122.012568"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2010"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.02.092"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.15420\/cfr.2022.12"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2023.1153994"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1671"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.031373"},{"key":"e_1_3_2_18_2","volume-title":"StatPearls","author":"Heward SJ","year":"2026","unstructured":"Heward SJ, Shams P, Widrich J. 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