Optimising coronary imaging decisions with machine learning: an external validation study
Background Exclusion of coronary stenosis in individuals with suggestive symptoms is challenging. Cardiac CT or coronary angiography is often used but is inefficient and costly and involves risks. Sex-stratified algorithms based on electronic health records (EHRs) could be a non-invasive alternative...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-05-01
|
| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/1/e003072.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849314290062852096 |
|---|---|
| author | Floor Groepenhoff Leonard Hofstra Sophie Heleen Bots Saskia Haitjema Imo Hoefer L. Malin Overmars Bram van Es Mark C. H. De Groot G. Aernout Somsen I. Igor Tulevski Hester M. den Ruijter Wouter W. van Solinge |
| author_facet | Floor Groepenhoff Leonard Hofstra Sophie Heleen Bots Saskia Haitjema Imo Hoefer L. Malin Overmars Bram van Es Mark C. H. De Groot G. Aernout Somsen I. Igor Tulevski Hester M. den Ruijter Wouter W. van Solinge |
| author_sort | Floor Groepenhoff |
| collection | DOAJ |
| description | Background Exclusion of coronary stenosis in individuals with suggestive symptoms is challenging. Cardiac CT or coronary angiography is often used but is inefficient and costly and involves risks. Sex-stratified algorithms based on electronic health records (EHRs) could be a non-invasive alternative for excluding coronary stenosis, yet their performance may vary by healthcare settings. Thus, external validation is crucial for determining their generalisability. This study aimed to externally validate sex-stratified machine learning algorithms based on EHR data to predict the absence of coronary stenosis, evaluated in diverse clinical settings.Methods Sex-stratified XGBoost algorithms were trained on EHR data from patients who underwent coronary imaging at the University Medical Center Utrecht (n=14 674) and externally tested on EHR data of 13 Cardiology centres in the Netherlands (n=9252). The outcome was defined as the absence of coronary stenosis, identified through text mining of radiology report conclusions, and predictive performance was assessed by negative predictive values (NPVs) and specificities.Results On the training cohort (9298 men (median age 55 years, 73% no coronary stenosis) and 5376 women (median age 59 years, 83% no coronary stenosis)), the algorithms showed NPVs and specificities of 0.95 and 0.14 in men and 0.93 and 0.26 in women, respectively. On the testing cohort (4762 men (median age 60 years, 60% no coronary stenosis) and 4490 women (median age 60 years, 83% no coronary stenosis)), the algorithm showed NPVs and specificities of 0.89 and 0.07 in men and 0.87 and 0.18 in women, respectively.Conclusions This study externally validates sex‐stratified machine learning algorithms using EHR data to non-invasively predict the absence of coronary stenosis, with high NPVs observed across settings. However, given the modest specificity and study limitations, these findings should be considered preliminary, warranting further refinement before clinical adoption. |
| format | Article |
| id | doaj-art-fbaeeed3abd54400a2f8126176c9d5bf |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-fbaeeed3abd54400a2f8126176c9d5bf2025-08-20T03:52:29ZengBMJ Publishing GroupOpen Heart2053-36242025-05-0112110.1136/openhrt-2024-003072Optimising coronary imaging decisions with machine learning: an external validation studyFloor Groepenhoff0Leonard Hofstra1Sophie Heleen Bots2Saskia Haitjema3Imo Hoefer4L. Malin Overmars5Bram van Es6Mark C. H. De Groot7G. Aernout Somsen8I. Igor Tulevski9Hester M. den Ruijter10Wouter W. van Solinge11Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, the NetherlandscardiologistLaboratory for Experimental Cardiology, Department of Cardiology, University Medical Center Utrecht, Utrecht, The NetherlandsCentral Diagnostic Laboratory, University Medical Centre Utrecht, Utrecht, The Netherlands3Clinical Diagnostic Laboratory, UMC Utrecht, UtrechtCentral Diagnostic Laboratory, University Medical Centre Utrecht, Utrecht, The NetherlandsCentral Diagnostic Laboratory, University Medical Centre Utrecht, Utrecht, The NetherlandsCentral Diagnostic Laboratory, University Medical Centre Utrecht, Utrecht, The NetherlandsCardiology, Cardiology Centers of the Netherlands, Utrecht, The NetherlandsCardiology, Cardiology Centers of the Netherlands, Amsterdam, The NetherlandsExperimental Cardiology, University Medical Center Utrecht, Utrecht, The NetherlandsCentral Diagnostic Laboratory, University Medical Centre Utrecht, Utrecht, The NetherlandsBackground Exclusion of coronary stenosis in individuals with suggestive symptoms is challenging. Cardiac CT or coronary angiography is often used but is inefficient and costly and involves risks. Sex-stratified algorithms based on electronic health records (EHRs) could be a non-invasive alternative for excluding coronary stenosis, yet their performance may vary by healthcare settings. Thus, external validation is crucial for determining their generalisability. This study aimed to externally validate sex-stratified machine learning algorithms based on EHR data to predict the absence of coronary stenosis, evaluated in diverse clinical settings.Methods Sex-stratified XGBoost algorithms were trained on EHR data from patients who underwent coronary imaging at the University Medical Center Utrecht (n=14 674) and externally tested on EHR data of 13 Cardiology centres in the Netherlands (n=9252). The outcome was defined as the absence of coronary stenosis, identified through text mining of radiology report conclusions, and predictive performance was assessed by negative predictive values (NPVs) and specificities.Results On the training cohort (9298 men (median age 55 years, 73% no coronary stenosis) and 5376 women (median age 59 years, 83% no coronary stenosis)), the algorithms showed NPVs and specificities of 0.95 and 0.14 in men and 0.93 and 0.26 in women, respectively. On the testing cohort (4762 men (median age 60 years, 60% no coronary stenosis) and 4490 women (median age 60 years, 83% no coronary stenosis)), the algorithm showed NPVs and specificities of 0.89 and 0.07 in men and 0.87 and 0.18 in women, respectively.Conclusions This study externally validates sex‐stratified machine learning algorithms using EHR data to non-invasively predict the absence of coronary stenosis, with high NPVs observed across settings. However, given the modest specificity and study limitations, these findings should be considered preliminary, warranting further refinement before clinical adoption.https://openheart.bmj.com/content/12/1/e003072.full |
| spellingShingle | Floor Groepenhoff Leonard Hofstra Sophie Heleen Bots Saskia Haitjema Imo Hoefer L. Malin Overmars Bram van Es Mark C. H. De Groot G. Aernout Somsen I. Igor Tulevski Hester M. den Ruijter Wouter W. van Solinge Optimising coronary imaging decisions with machine learning: an external validation study Open Heart |
| title | Optimising coronary imaging decisions with machine learning: an external validation study |
| title_full | Optimising coronary imaging decisions with machine learning: an external validation study |
| title_fullStr | Optimising coronary imaging decisions with machine learning: an external validation study |
| title_full_unstemmed | Optimising coronary imaging decisions with machine learning: an external validation study |
| title_short | Optimising coronary imaging decisions with machine learning: an external validation study |
| title_sort | optimising coronary imaging decisions with machine learning an external validation study |
| url | https://openheart.bmj.com/content/12/1/e003072.full |
| work_keys_str_mv | AT floorgroepenhoff optimisingcoronaryimagingdecisionswithmachinelearninganexternalvalidationstudy AT leonardhofstra optimisingcoronaryimagingdecisionswithmachinelearninganexternalvalidationstudy AT sophieheleenbots optimisingcoronaryimagingdecisionswithmachinelearninganexternalvalidationstudy AT saskiahaitjema optimisingcoronaryimagingdecisionswithmachinelearninganexternalvalidationstudy AT imohoefer optimisingcoronaryimagingdecisionswithmachinelearninganexternalvalidationstudy AT lmalinovermars optimisingcoronaryimagingdecisionswithmachinelearninganexternalvalidationstudy AT bramvanes optimisingcoronaryimagingdecisionswithmachinelearninganexternalvalidationstudy AT markchdegroot optimisingcoronaryimagingdecisionswithmachinelearninganexternalvalidationstudy AT gaernoutsomsen optimisingcoronaryimagingdecisionswithmachinelearninganexternalvalidationstudy AT iigortulevski optimisingcoronaryimagingdecisionswithmachinelearninganexternalvalidationstudy AT hestermdenruijter optimisingcoronaryimagingdecisionswithmachinelearninganexternalvalidationstudy AT wouterwvansolinge optimisingcoronaryimagingdecisionswithmachinelearninganexternalvalidationstudy |