Discussion
CAD, myocardial ischemia, obstructive CAD
CORONARY STENOSIS, MYOCARDIAL ISCHEMIA, CAD, STENOSES
This might be the first study on the diagnostic model of CAD using novel echocardiography tools (MW and LA strain) integrated with ML models. This superior CAD detection model showed a value of ROC AUC (0.852) with a sensitivity of 0.95 and specificity of 0.69 in the test group, while the ROC AUC value was 0.834 in the validation data set. Our model was very sensitive in detecting CAD patients. We found that MW and LA strain-based ML approach has great potential to screen CAD patients.The application of imaging techniques in clinics plays an important role in the diagnosis and prognosis of CAD, reducing the morbidity and mortality of CAD patients. Due to its feasibility and reliability, echocardiography is still the most commonly used imaging tool for diagnosing heart problems. Traditionally, the conventional echocardiographic parameter used to evaluate the presence or absence of CAD has mainly been segmental wall motion abnormalities by visualization using nude eye observation, which may miss some subtle abnormalities [A total of 818 patients were enrolled in this study. The median sample size in the previous reports is approximately 350 [Coronary angiography is generally considered a gold standard for CAD diagnosis. However, coronary angiography is complex, costly, and has side effects. In contrast, the echocardiography-based methods were suitable for almost all patients, but it has been rarely reported about the clinical applications of the models that can combine novel echocardiographic methods, as mentioned above, to improve diagnostic performance. To this end, our ML model provides an approach to solving this problem. Our model demonstrated its sensitivity of 0.952 and specificity of 0.691 in the test group and its AUC of 0.852. Although the accuracy of our model was similar to that of other studies, it is notable that the inclusion criteria in our study were broader than those in the most published studies, which were closer to real-world conditions, suggesting a high sensitivity of our model, which might be used for screening the CAD patients in clinics to allow early diagnosis and treatment.Coronary angiography mainly reflects anatomical stenoses, but it cannot reflect functional problems, while strain can partly reflect functional problems. Strain is mainly a reflection of myocardial function rather than the anatomic coronary stenosis itself. In clinical practice, many patients had myocardial ischemia without obstructive CAD [ML algorithms have been widely used for analyzing medical images [