When Diagnosis Is Made By Playing 'Shuffled Cards': A Non-Invasive, Real-Time, Adaptive Method to Functionally Evaluate Coronary Artery Based on Coronary Angiography

Aims The great value concealed in the sequence of coronary angiography frames is not discovered in the world. We discovered and demonstrated the “Sequence Value” concealed in the coronary angiography and proposed DZL (Disarranged Zone Learning) to realize the sequence value in functional evaluation of coronary artery disease. Furthermore, we automated the DZL using a deep learning model to release huge medical resources. Methods and Results We gave a novel definition of TIMI flow grade using the term temporal and spatial coupling tightness (TSCT) of the antegrade contrast agent. We used the TSCT to model the myocardial ischemia in a functional perspective and used the PCI conduction after CAG as the outcome event of myocardial ischemia. We proposed a novel method (Disarranged Zone Learning) to measure TSCT and we designed an experiment to validate its effectiveness. We further automated the novel method using an unsupervised deep learning model. The prediction accuracy of the model was applied as a proxy of myocardial ischemia. We further proposed Difference DZL to quantify the functional capability of any specific vessel segment. DZL overall AUC reaches 0.92. DZL automation reveals an AUC of 0.84 (95%CI, 0.81-0.87). Conclusion We unprecedentedly discovered the “Sequence Value” concealed in coronary angiography. We then proposed a novel method termed DZL to functionally evaluate the coronary artery in a non-invasive, real-time and adaptive manner. Disclosure The Authors declare that there is no conflict of interest. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors