Multistage Electrocardiographic Profiling for Mental Stress-Induced Myocardial Ischemia in Women: A Prospective, Age-Matched Cohort Study in China
Authors' conclusion
Multistage ECG analysis, particularly heart rate variability, captures electrophysiological signatures of mental stress-induced myocardial ischemia and enhances noninvasive detection. These findings support a paradigm shift from single-phase, ischemia-focused ECG interpretation to dynamic, multivariable assessment, providing a foundation for early identification and personalized risk stratification in women with nonobstructive coronary disease.
Study context
- Population
- Women (18–75 years) with angina, nonobstructive coronary artery disease, and age-matched healthy controls, Guangzhou, China
- Participants
- 119 vs 53
- Exposure
- Machine learning classifiers using single-stage, multistage, and interstage ECG features against positron emission tomography/computed tomography labeling of mental stress-induced myocardial ischemia
- Study cohortn = 119
- Test cohortn = 53
- Outcome
- Intrastage features differing across Rest, Stress, and Recovery
Methodological detailssingle-center tertiary hospital, machine learning
- Single-center tertiary hospital
- Machine learning
Main finding
As reported in the abstract
Study cohort
103 of 264
events
- Significant heart rate variability, heart rate asymmetry, and prognostic-related changes
- P < 0.05
Observational data: associations, not effects.
Further findings
- Interstage features showing significant group differences — study cohort
- 73 of 264 events
Model performance in test cohort
- Models using multistage and interstage features all outperformed single-stage models
- Mean age 53±7 years
Original publication
Multistage Electrocardiographic Profiling for Mental Stress-Induced Myocardial Ischemia in Women: A Prospective, Age-Matched Cohort Study in China. Circ Popul Health Outcomes. Published 16 February 2026. doi:10.
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