{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:14:21Z","timestamp":1788243261327,"version":"build-2803163510"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"\n Purpose<\/jats:title>\n This study aims to evaluate whether combining tongue manifestation parameters with blood metabolic biomarkers improves LASSO of carotid vulnerable plaques in patients with coronary heart disease (CHD), and to develop and compare the diagnostic performance of multiple machine-learning models.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively collected clinical data from 523 patients with CHD. Based on carotid ultrasound, patients were classified into vulnerable-plaque and non-vulnerable-plaque groups. We compared baseline characteristics, tongue manifestation parameters, and blood metabolic biomarkers between the two groups. The dataset was randomly split into training and validation sets at a 6:4 ratio. Factors associated with carotid vulnerable plaques in CHD were identified by intergroup comparison and LASSO regression, and four machine-learning algorithms were used to build predictive models.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Significant differences were found between the two groups in age, BMI,APOA1, FBG, AST, K\n +<\/jats:sup>\n ,Na\n +<\/jats:sup>\n , BUN, PT, and APTT (\n P<\/jats:italic>\n \u2009&lt;\u20090.05). The R, G, and B values of the mid-tongue, tongue tip, right tongue, and the whole tongue also differed significantly between the vulnerable-plaque and non-vulnerable-plaque groups (\n P<\/jats:italic>\n \u2009&lt;\u20090.05). Tongue manifestation parameters correlated significantly with biomarkers including APOA1, FBG, PT, and APTT (\n P<\/jats:italic>\n \u2009&lt;\u20090.05). The LightGBM model has a high degree of discrimination in performance, with an AUC of 0.727 for the validation set.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n There is a weak correlation between tongue image parameters and some blood metabolic markers, suggesting that the two may reflect the pathophysiological state of the body from different dimensions. Tongue image parameters, as non-invasive and simple assessment indicators, provide a preliminary exploratory reference for the risk stratification of coronary heart disease. However, their independent predictive value and clinical practicability still need to be further verified by prospective large-sample studies.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1852366","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:25:09Z","timestamp":1788240309000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Carotid vulnerable plaque in coronary heart disease: a machine learning-based diagnostic model integrating tongue parameters and blood metabolic biomarkers"],"prefix":"10.3389","volume":"13","author":[{"given":"Xinang","family":"Xiao","sequence":"first","affiliation":[{"name":"School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine (SHUTCM)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jieyun","family":"Li","sequence":"additional","affiliation":[{"name":"School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine (SHUTCM)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi","family":"Zhou","sequence":"additional","affiliation":[{"name":"School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine (SHUTCM)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Gao","sequence":"additional","affiliation":[{"name":"School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine (SHUTCM)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingsheng","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine (SHUTCM)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumo","family":"Xia","sequence":"additional","affiliation":[{"name":"School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine (SHUTCM)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiekee","family":"Lim","sequence":"additional","affiliation":[{"name":"School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine (SHUTCM)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaoxia","family":"Xu","sequence":"additional","affiliation":[{"name":"School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine (SHUTCM)","place":["Shanghai, China"]},{"name":"Key Laboratory of Health Identification and Assessment of Shanghai","place":["Shanghai"]},{"name":"Guangde Traditional Chinese Medicine Clinic","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"B1","first-page":"393","article-title":"Association between coronary atherosclerotic heart disease and carotid atherosclerotic plaques and its impact on patient prognosis","volume":"28","author":"Bai","year":"2022","journal-title":"Thromb Hemost"},{"key":"B2","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.pcad.2021.03.005","article-title":"Carotid stenosis, stroke, and carotid artery revascularization","volume":"65","author":"Heck","year":"2021","journal-title":"Prog Cardiovasc Dis"},{"key":"B3","first-page":"111","article-title":"Clinical value of carotid ultrasound in diagnosing carotid plaque vulnerability for predicting severity of coronary artery disease","volume":"28","author":"Peng","year":"2022","journal-title":"J Clin Psychosom Dis"},{"key":"B4","first-page":"79","article-title":"Correlation between carotid plaque vulnerability and cerebrovascular accidents","volume":"25","author":"Li","year":"2018","journal-title":"Chin J Contemp Med"},{"key":"B5","first-page":"1327","article-title":"Clinical study on the relationship between tongue manifestation and inflammatory activity in primary gout","volume":"28","author":"He","year":"2019","journal-title":"Chin J Emerg Tradit Chin Med"},{"key":"B6","first-page":"1259","article-title":"Clinical significance of tongue diagnosis in the prodromal diagnosis of stroke","volume":"61","author":"Shi","year":"2020","journal-title":"J Tradit Chin Med"},{"key":"B7","first-page":"356","article-title":"Study on tongue manifestation characteristics in 281 patients with menstrual disorders","volume":"63","author":"Guo","year":"2022","journal-title":"J Tradit Chin Med"},{"key":"B8","unstructured":"Cheng\n MY\n \n \n Study on the distribution of traditional Chinese medicine syndrome elements and correlation between arterial stiffness parameters and coronary lesion severity in elderly patients with stable angina pectoris\n \n 2023"},{"key":"B9","first-page":"64","article-title":"Correlation of serum lipoprotein-associated phospholipase A2, uric acid, and cystatin C with vulnerable carotid plaques","volume":"20","author":"Wang","year":"2022","journal-title":"J Yan'an Univ (Med Sci Ed)"},{"key":"B10","first-page":"923","article-title":"Influencing factors and nomogram model for vulnerable carotid plaques in middle-aged and elderly physical examination population","volume":"21","author":"Zhang","year":"2022","journal-title":"Chin J Mult Organ Dis Elderly"},{"key":"B11","first-page":"1288","article-title":"Relationship between vulnerable carotid atherosclerotic plaques and serum RBP4 levels and oxidative stress in elderly patients with cerebral infarction","volume":"35","author":"Wang","year":"2022","journal-title":"J Med Postgrad"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e047902","DOI":"10.1161\/JAHA.125.047902","article-title":"Association of composite metabolic indices with incident carotid plaque: a Chinese cohort study","volume":"15","author":"He","year":"2026","journal-title":"J Am Heart Assoc"},{"key":"B13","doi-asserted-by":"publisher","first-page":"120592","DOI":"10.1016\/j.atherosclerosis.2025.120592","article-title":"AI-ECG age predicts carotid atherosclerotic plaque volume and progression","volume":"412","author":"Pavluk","year":"2026","journal-title":"Atherosclerosis"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e043224","DOI":"10.1161\/JAHA.125.043224","article-title":"Cerebrovascular risk factors for body mass index, diabetes, and atherosclerosis in a Wisconsin Native American population: a cross-sectional observation study","volume":"15","author":"Mitchell","year":"2026","journal-title":"J Am Heart Assoc"},{"key":"B15","first-page":"2444","article-title":"Construction of a vulnerable carotid plaque model in high-risk stroke population based on clinical baseline characteristics and carotid ultrasound parameters","volume":"29","author":"Qin","year":"2025","journal-title":"Chin J Tissue Eng Res"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.13422\/j.cnki.syfjx.20250912","article-title":"Construction and validation of an integrated Chinese and Western medicine risk prediction model for carotid plaques in 3,009 high-risk stroke patients","author":"Qin","year":"2025","journal-title":"Chin J Exp Tradit Med Formulae"},{"key":"B17","first-page":"107","article-title":"Advances in revascularization strategies for stable coronary artery disease: interpretation of the 2018 Chinese guidelines for diagnosis and treatment of stable coronary artery disease","volume":"19","author":"Shen","year":"2019","journal-title":"Cardiocerebrovasc Dis Prev Treat"},{"key":"B18","first-page":"346","article-title":"Expert consensus on several issues regarding head and neck vascular ultrasound (carotid artery section)","volume":"17","year":"2020","journal-title":"Chin J Cerebrovasc Dis"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1436278","DOI":"10.3389\/fcvm.2024.1436278","article-title":"Tongue color parameters in predicting the degree of coronary stenosis: a retrospective cohort study of 282 patients with coronary angiography","volume":"11","author":"Li","year":"2024","journal-title":"Front Cardiovasc Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2086","DOI":"10.3390\/foods11142086","article-title":"Prediction of total soluble solids and pH of strawberry fruits using RGB, HSV and HSL colour spaces and machine learning models","volume":"11","author":"Basak","year":"2022","journal-title":"Foods"},{"key":"B21","doi-asserted-by":"publisher","first-page":"109423","DOI":"10.1016\/j.jneumeth.2021.109423","article-title":"A visual-degradation-inspired model with HSV color-encoding for contour detection","volume":"369","author":"Zhong","year":"2022","journal-title":"J Neurosci Methods"},{"key":"B22","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1097\/SLA.0000000000005616","article-title":"Machine learning risk prediction model of 90-day mortality after gastrectomy for cancer","volume":"276","author":"Pera","year":"2022","journal-title":"Ann Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.4143\/crt.2022.1330","article-title":"Development and validation of models to predict lymph node metastasis in early gastric cancer using logistic regression and gradient boosting machine methods","volume":"55","author":"Lee","year":"2023","journal-title":"Cancer Res Treat"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e008927","DOI":"10.1136\/jitc-2024-008927","article-title":"Development and interpretation of a pathomics-driven ensemble model for predicting the response to immunotherapy in gastric cancer","volume":"12","author":"Han","year":"2024","journal-title":"J Immunother Cancer"},{"key":"B25","first-page":"1767","article-title":"Study on tongue image features in patients with carotid atherosclerosis","volume":"31","author":"Zhou","year":"2020","journal-title":"Lishizhen Med Mater Med Res"},{"key":"B26","first-page":"15","article-title":"Correlation between objective tongue manifestation and gastric inflammatory response in patients with gastric ulcer","volume":"39","author":"Zhou","year":"2016","journal-title":"Guangxi J Tradit Chin Med"},{"key":"B27","unstructured":"Zhu\n YW\n \n \n Study on tongue manifestation and its correlation with inflammatory markers in primary gout\n \n 2018"},{"key":"B28","first-page":"1226","article-title":"Correlation of carotid plaque characteristics assessed by CTA with serum Hcy, Cys-C, APOA1, and UA in patients with ischemic stroke and T2DM","volume":"40","author":"Jin","year":"2022","journal-title":"Imaging Sci Photochem"},{"key":"B29","first-page":"1157","article-title":"Correlation between serum soluble low-density lipoprotein receptor 11 level and carotid intima-media thickness in patients with hypertension and diabetes","volume":"27","author":"Zheng","year":"2019","journal-title":"Chin J Hypertens"},{"key":"B30","first-page":"341","article-title":"Mechanism of angiopoietin-like protein 8 mediating hypertension to promote atherosclerosis","volume":"49","author":"Yang","year":"2022","journal-title":"Int J Cardiovasc Dis"},{"key":"B31","first-page":"1677","article-title":"Mechanism of raw hawthorn beverage in preventing hypertensive vascular disease based on the theory of \u201csalt counteracting blood\u201d from the yellow emperor\u2019s inner canon","volume":"37","author":"Guo","year":"2019","journal-title":"Chin Arch Tradit Chin Med"},{"key":"B32","first-page":"730","article-title":"Advances in the cellular mechanisms of atherosclerosis","volume":"46","author":"Zhang","year":"2025","journal-title":"J Hebei Med Univ"},{"key":"B33","first-page":"769","article-title":"Predictive value of CT-based deep transfer learning model for BRAF V600E mutation in thyroid nodules","volume":"23","author":"Wang","year":"2025","journal-title":"Chin J Integr Tradit West Med Imaging"},{"key":"B34","first-page":"9","article-title":"Risk prediction and causative analysis of T2DM complicated with carotid plaque based on XGBoost algorithm","volume":"46","author":"Li","year":"2025","journal-title":"Med Equip"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1989","DOI":"10.1109\/EMBC48229.2022.9871111","article-title":"The robustness of random forest and support vector machine algorithms to a faulty heart sound segmentation","volume":"2022","author":"Oliveira","year":"2022","journal-title":"Annu Int Conf IEEE Eng Med Biol Soc"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1852366\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:25:14Z","timestamp":1788240314000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1852366\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":35,"alternative-id":["10.3389\/fcvm.2026.1852366"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1852366","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]},"article-number":"1852366"}}