Endotypes of angina with non-obstructive coronary arteries
Bibliographic record
Abstract
Abstract Background Angina with non-obstructive coronary arteries (ANOCA) is a prevalent myocardial ischemic syndrome. Mechanisms of ischemia are challenging to assess and medical therapy is empirical. Methods Patients with suspected ANOCA were prospectively enrolled in nine centers in Europe and North America. Hemodynamic endotypes were assessed measuring coronary flow reserve and resistance using an intracoronary pressure- and temperature-sensitive sensor and bolus thermodilution. Measurements were obtained during resting conditions and following intracoronary infusion of adenosine and acetylcholine. Chest pain and electrocardiographic ischemic changes were also recorded. The participant characteristics associated with each hemodynamic endotype were investigated using regression analysis. A three-step Delphi consensus method to identify endotype-specific therapies was completed by thirteen invasive cardiologists. Results 1001 participants (mean age 62±11years, 56% female) were enrolled and eight distinct endotypes were defined by adenosine testing (n=3) and acetylcholine testing (n=5), respectively: elevated resting coronary blood flow, n=195 (19%); impaired endothelium-independent vasodilation, n=125 (13%); compensated endothelium-independent dysfunction, n=112 (11%); epicardial coronary spasm, n=162(17%); microvascular spasm, n=75 (8%); endothelial dysfunction, n=96 (10%); ischemia w/o hemodynamic changes (microvascular steal), n=68 (7%); and enhanced cardiac nociception, n=79 (8%). More than one endotype occurred in 186(19%) individuals and normal responses occurred in 234 (23%) individuals. Each endotype was associated with distinct clinical correlates. The Delphi clinician consensus (100% "agree" or "strongly agree") identified endotype-specific medical therapy with a Likert scale score ≥6 for all endotypes. Conclusion In patients with suspected ANOCA a systematic assessment of the symptomatic, electrocardiographic and hemodynamic responses to adenosine and acetylcholine identifies distinct endotypes and enables mechanism-guided stratified angina therapy.Summary of Endotypes Heat Map of Endotypes and risk factors
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| 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".