Vasoactive breathing manoeuvres as an effective coronary vasodilator in patients with suspected coronary artery disease: a prospective comparative oxygenation-sensitive CMR study
Bibliographic record
Abstract
Abstract Aims In the assessment of myocardial ischaemia, vasoactive breathing manoeuvres have been proposed as a potential alternative to pharmacological vasodilator stress. However, it remains unclear whether the resultant physiological responses are comparable to those induced by adenosine in patients with suspected coronary artery disease (CAD). We sought to compare the myocardial oxygenation responses to a hyperventilation breath-hold (HVBH) manoeuvre with those elicited by adenosine, using oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR). Methods and results Patients with suspected angina underwent 3-Tesla OS-CMR with (i) HVBH and (ii) adenosine (140–210 μg/kg/min) prior to invasive coronary angiography. The primary outcome was the maximal percentage change in OS-CMR signal intensity for (i) HVBH [breathing-induced myocardial oxygenation reserve (B-MOREmax)] and (ii) adenosine [adenosine-induced myocardial oxygenation reserve (A-MORE)]. Significant CAD was defined as fractional flow reserve ≤0.80 in epicardial vessels ≥2 mm diameter. From 53 prospectively recruited patients, 44 had complete, paired OS-CMR sequences (mean age 69 ± 9 years, 75% male, CAD prevalence 59%). The HVBH manoeuvre elicited a myocardial oxygenation response comparable to that of adenosine (B-MOREmax 7.0 ± 9.5% vs. A-MORE 8.6 ± 12.3%, mean difference: −1.6% [−6.0%, 2.8%]; P = 0.469), which remained similar at the segmental level following adjustment for age, sex, cardiovascular comorbidities, CAD, and infarction (mean difference: −1.7% [−4.0%, 0.5%]; P = 0.126). Conclusion In patients with suspected CAD, HVBH induces a myocardial oxygenation response comparable to that elicited by adenosine. Future prospective studies evaluating the diagnostic accuracy of OS-CMR combined with vasoactive breathing manoeuvres for detecting significant CAD are warranted.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".