Breathomics and Single Channel Electrocardiogram in Coronary Artery Disease

Study Overview
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Brief Summary
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This is a prospective case-control single center observational non-randomized study. It is carried out to evaluate the diagnostic accuracy of functional tests with physical load under the control of a 12-channel ECG together with analysis of the parameters of volatile organic compounds of the exhaled breath, and single-channel ECG data.

Detailed Description
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The planned number of participants to include in the study is 60, admitted to the University Clinical Hospitals No. 1, at the I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). The study includes the following stages: Participants will be selected according to inclusion and exclusion criteria; Work with medical documentation; Instrumental and laboratory examinations of the participants: 3.1. Analysis of exhaled air will be carried out with the Compact PTR-MS instrument manufactured by Ionicon (Austria) (analytical device), registration certificate No. (C16)07/C05. 3.2. Cardio ankle vascular index (CAVI) analysis will be conducted before the physical exertion, using the Fukuda Denshi apparatus (Japan), a microphone for cardio-phonogram measurements fixed with double-sided tape over the sternum in the second intercostal space. 3.3. All the participants will undergo a single blood sampling, during the day of performing of the study, blood test: 10 ml from a peripheral vein to determine the level of total cholesterol, low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), high-density lipoprotein (HDL), Chylomicron, triglycerides, C-reactive protein (CRP), lipoprotein A little, apolipoprotein B, interleukin-6 (IL-6), interleukin-3 beta (IL-3 beta). 3.5. Both groups will perform a bicycle ergometry (on SCHILLER device) test to evaluate the response to physical activity. 3.6. Before and immediately after the exercise test, all patients are scheduled to record a single-channel ECG and pulse wave, using a portable single-channel recorder (Cardio-Qvark) (Russia, Moscow). ECG and pulse wave results will be interpreted using machine learning models. 4.6. Computed tomography myocardial perfusion imaging on a CT with 640 slices (Canon) during stress with Adenosine triphosphate will be performed. After completion of the instrumental and laboratory analysis, a statistical analysis will be conducted.

Official Title
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Biomarkers of the Exhaled Breath and Single-channel Electrocardiography in the Diagnosis of Myocardial Ischemia

Conditions
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Coronary Artery Disease

Intervention / Treatment
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* Diagnostic Test: Mass spectrometry using the PTR TOF-1000 (IONICON PTR-TOF-MS - Trace VOC Analyzer, Eduard-Bodem-Gasse 3, 6020 Innsbruck, Austria (Europe).


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants age ≥ 40 years. Patients with intact mental and physical activity. Written consent to participate in the study, take blood tests, and anonymously publish the results of the study. The participants of the control group are individuals without coronary artery disease, confirmed by the absence of the myocardial perfusion defect on the adenosine triphosphate stress myocardial perfusion computed tomography, and confirmed by medical history, previous medical tests, and retrospective interview of participants, and they will mainly be athletes. The participants of the experimental group are individuals with coronary artery disease, confirmed by myocardial perfusion defect on the adenosine triphosphate stress myocardial perfusion computed tomography, and confirmed by medical history, previous medical tests, and retrospective interview of participants. Non-inclusion criteria: Pregnancy. Presence of signs of acute coronary syndrome (myocardial infarction in the last two days), history of myocardial infarction; Active infectious and non-infectious inflammatory diseases in the exacerbation phase; Respiratory diseases (bronchial asthma, chronic bronchitis, cystic fibrosis); Acute thromboembolism of pulmonary artery branches; Aortic dissection; Critical heart defects; Active oncopathology; Decompensation phase of acute heart failure; Neurological pathology (Parkinson's disease, multiple sclerosis, acute psychosis, Guillain-Barré syndrome); Cardiac arrhythmias that do not allow exercise ECG testing (Wolff-Parkinson-White syndrome, Sick sinus syndrome, AV block of II-III-degree, persistent ventricular tachycardia); Diseases of the musculoskeletal system that prevent passing a stress test (bicycle ergometry); Allergic reaction to iodine. Exclusion Criteria: Poor single-channel ECG and pulse wave recording quality Failure of the stress test stop criterion Reluctance to continue participating in the study.

Ages Eligible for Study
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Minimum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental group<br>The group is planned to include 30 people with myocardial perfusion defect on the stress computed tomography myocardial perfusion Imaging (by using contrast enhanced multi-slice spiral computed tomography (CE-MSCT) using adenosine triphosphate (ATP)). | Diagnostic Test: Mass spectrometry using the PTR TOF-1000 (IONICON PTR-TOF-MS - Trace VOC Analyzer, Eduard-Bodem-Gasse 3, 6020 Innsbruck, Austria (Europe).<br>* Once enrolled in the study, all participants are scheduled to undergo the following tests: The analysis of volatile organic compounds obtained from exhaled air will be carried out by a combination of real-time analytical methods, the use of a real-time mass spectrometer with ionization by the proton transfer method. Before and immediately after the exercise test, all patients are scheduled to record a single-channel ECG and pulse wave, using a portable single-channel recorder (Cardio-Qvark) (Russia, Moscow). ECG and pulse wave results are interpreted using machine learning models.<br>|
| Control group<br>The group is planned to include 30 people without myocardial perfusion defect on the stress computed tomography myocardial perfusion imaging (by using contrast enhanced multi-slice spiral computed tomography (CE-MSCT) using adenosine triphosphate (ATP)). | Diagnostic Test: Mass spectrometry using the PTR TOF-1000 (IONICON PTR-TOF-MS - Trace VOC Analyzer, Eduard-Bodem-Gasse 3, 6020 Innsbruck, Austria (Europe).<br>* Once enrolled in the study, all participants are scheduled to undergo the following tests: The analysis of volatile organic compounds obtained from exhaled air will be carried out by a combination of real-time analytical methods, the use of a real-time mass spectrometer with ionization by the proton transfer method. Before and immediately after the exercise test, all patients are scheduled to record a single-channel ECG and pulse wave, using a portable single-channel recorder (Cardio-Qvark) (Russia, Moscow). ECG and pulse wave results are interpreted using machine learning models.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in the concentration of several volatile organic compounds in exhaled air at rest, correlating with the presence or absence of coronary insufficiency, will be revealed. | By analysis the components of the exhaled air in individuals with myocardial perfusion defect on Stress Myocardial Perfusion Computed Tomography and compare them with individuals without myocardial perfusion defect at rest, as independent and dependent variables. | After the study is complete in March 2026, the data will be analyzed and interpreted. The primary outcomes are expected to be ready in September 2026. | 
| Changes in the concentration of several volatile organic compounds in the exhaled air before and after physical exertion will be detected, increasing the accuracy of the stress ECG test. | By analysis the components of the exhaled air in individuals with myocardial perfusion defect on Stress Myocardial Perfusion Computed Tomography and compare them with individuals without myocardial perfusion defect after physical stress test and compare it with rest results, as independent and dependent variables. | After the study is complete in March 2026, the data will be analyzed and interpreted. The primary outcomes are expected to be ready in September 2026. | 
| The parameters of single-channel ECG and pulse wave, both at rest and after physical stress test, predicting the presence of significant coronary insufficiency, will be determined. | By analysis the components of the single channel electrocardiography in individuals with myocardial perfusion defect on Adenosine Triphosphate Stress Myocardial Perfusion Computed Tomography and compare them with individuals without myocardial perfusion defect using machine learning models in interpretation of the primary electrocardiography and pulse wave data, as dependent and independent variables. | After the study is complete in March 2026, the data will be analyzed and interpreted. The primary outcomes are expected to be ready in September 2026. | 
| Changes in the concentration of lipidome and inflammasome in individuals with coronary artery disease and individuals without coronary artery disease. | By analysis of the taken blood samples for lipidome and inflammasome biomarkers in individuals with myocardial perfusion defect on Stress Myocardial Perfusion Computed Tomography and compare them with individuals without myocardial perfusion defect at rest, as independent variables. | After the study is complete in March 2026, the data will be analyzed and interpreted. The primary outcomes are expected to be ready in September 2026. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Coronary artery disease, Mass spectrometry, Volatilome, ECG