Improvement of angina after treating focal coronary artery disease undetected in resting conditions
Bibliographic record
Abstract
A 65-year-old woman without cardiovascular risk factors presented with stable angina Canadian Cardiovascular Society (CCS) Class II. The 7-item Seattle Angina Questionnaire (SAQ-7) indicated frequent angina, moderate physical limitation, and low quality of life for a summary score of 50/100. Coronary CT and invasive angiography revealed severe stenosis in the mid-left anterior descending (LAD) coronary artery with a minimum lumen area (MLA) of 0.9 mm2 and mixed plaque (Figures 1A and B). Intravascular ultrasound (IVUS) confirmed small MLA and 84% plaque burden (Figure 1A, right panels). The resting full-cycle ratio (RFR) was negative (0.93), whereas fractional flow reserve (FFR) was positive (0.75) with a focal pressure step-up in the pullback curve as quantified by a high pullback pressure gradient (PPG) index of 0.79 (Figures 1C and D). The patient underwent percutaneous coronary intervention (PCI) with one drug-eluting stent (Figure 1E). Post-PCI IVUS confirmed good stent expansion. Post-PCI FFR increased to 0.92 without residual focal pressure gradients in the pullback curve (Figure 1F), and normal microcirculation function demonstrated by a coronary flow reserve (CFR) of 7.8 and index of microvascular resistance (IMR) of 16 (Figure 1G). RFR remained unchanged at 0.94. The SAQ-7 at 1-year follow-up showed complete symptoms resolution and improvement in all domains (Figure 1H). A symptomatic patient with obstructive focal epicardial disease yet a negative resting index experienced relief from angina after PCI. This case highlights the usefulness of a comprehensive physiological assessment in cases considered for revascularization, particularly with focal lesions. All authors and contributor roles, Hitoshi Matsuo (MD, PhD), Collet Bortone Carlos (MD, PhD), and Koshiro Sakai (MD, PhD) C.C. received research grants from Biosensors, HeartFlow, and Abbott Vascular; and has received consultancy fees from HeartFlow, Abbott Vascular, Boston Scientific, Opsens, and Philips/Volcano. H.M. serves as an advisory board member for Zeon Medical; and receives lecture fees from Abbott Vascular Japan, Boston Scientific Japan, and Phillips Japan. The other author has nothing to disclose. No new data were generated or analysed in support of this research. This patient was included in the PPG Global study (NCT04789317) sponsored by the Cardiovascular Research Center Aalst with a research grant from Abbott Vascular. All authors declare no funding for this contribution. Pre and post-PCI physiological assessment.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".