Letter by Savas and Kalay Regarding Article, “Invasive Evaluation of Patients With Angina in the Absence of Obstructive Coronary Artery Disease”
Bibliographic record
Abstract
We read with great interest the report by Lee et al 1 in a previous issue of Circulation.The authors reported that invasive assessment of patients with angina in the absence of obstructive coronary artery disease (CAD) may provide important diagnostic information.The investigators found that 77% of patients had occult coronary abnormalities, diagnosed with endothelial function tests and intravascular ultrasound.Although these are important findings, some issues should be considered in the interpretation of the study results.It is well known that increased myocardial wall tension and reduced coronary flow reserve cause angina in the hypertensive population. 2 In a previous study, Iriarte et al 3 stated that typical angina in hypertensive patients was common (30%) and that 61% of these patients had normal coronary arteries.Current guidelines recommend that blood pressure should be lowered to <140/90 mm Hg in patients with CAD to control anginal symptoms.However, in the present study, the authors did not mention the classification of blood pressure.In our opinion, the high rate of coronary abnormalities in patients with nonobstructive CAD may be the result of neglecting hypertension.Blood pressure values should be evaluated in patients with angina.On the other hand, a previous study showed that the prevalence of depression is considerably high (63%) among patients with chest pain in the absence of obstructive CAD. 4 Therefore, screening for depression in patients with CAD is now recommended by the American Heart Association.This is an important issue because depression is a predictor of treatment success.Anginal symptoms may regress if patients are treated with an antidepressant.In addition, Chen et al 5 stated that depression and stress were associated with impaired endothelial function parameters.Accordingly, depression and stress may have changed the hemodynamic parameters in the present study.Therefore, depression should be considered in evaluating patients with angina.In this way, comprehensive invasive assessment of patients with angina may not be necessary.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.031 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.004 | 0.005 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.027 | 0.031 |
| Insufficient payload (model declined to judge) | 0.006 | 0.009 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".