AbstractBackgroundThe cardiodynamicsgram (CDG), a novel noninvasive method, extracts dynamic ST‐T segment information from an electrocardiogram (ECG) through deterministic learning.HypothesisThe CDG can reflect anomalous functional information in coronary artery disease (CAD).MethodsWe retrospectively enrolled 456 patients with suspected CAD who underwent coronary computed tomography angiography (CCTA) from January 2020 to 2022, followed immediately by standard 12‐lead ECG acquisition. Positivity for CAD were defined as CCTA ≥ 50% or CT‐derived fractional flow reserve (CT‐FFR) ≤ 0.8. A CDG value <0 was considered negative; otherwise, it was considered positive. We also evaluated the diagnostic performance of the CDG in the ECG‐diagnosis‐negative subgroup and in patients who had undergone invasive coronary angiography (ICA) after CCTA.ResultsOf 362 patients, 168 (46.41%) were positive for CAD, and 178 (49.17%) were men. The median age was 59 (52−66) years. The accuracy of the CDG in the diagnosis of CAD was 79.56%, with a sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) of 75.60%, 82.99%, and 0.836 (95% CI: 0.794−0.878), respectively. Similarly, in the ECG‐diagnosis–negative subgroup (n= 223), the accuracy of the CDG was 80.27%, with an AUC of 0.842 (95% CI: 0.790−0.895). Among the 11 patients with CAD confirmed by ICA, 10 were diagnosed positive by the CDG. Furthermore, the CDG values and CT‐FFR were correlated (r= −.395;p< .001).ConclusionsThe ECG‐based CDG has relatively high specificity and accuracy for the diagnosis of CAD and reflects functional cardiac information to some extent. It has the potential to be used as a screening tool for suspected CAD patients before CCTA.