Volatilome and machine learning in ischemic heart disease: Current challenges and future perspectives

Figure 1 Integration of exhaled breath analysis into the current diagnostic pathway for ischemic heart disease. Clinical decision-making typically begins with an assessment of pre-test probability. Patients with < 5% risk undergo accessible but low-accuracy methods such as 12-lead electrocardiography physical stress tests and cardiovascular risk-scoring systems (SCORE2, SCORE2-OP, SMART). Patients with ≥ 5% risk are directed to high-accuracy modalities such as coronary computed tomography angiography, with or without pharmacological stress testing. However, these tests are resource-intensive, require specialized personnel, and are not universally available. Introducing exhaled breath analysis as an adjunct diagnostic tool can serve as a cost-effective alternative to improve the area under the receiver operating characteristic curve, thereby enhancing diagnostic and prognostic accuracy for ischemic heart disease. AUC: Area under the receiver operating characteristic curve; CCTA: Coronary computed tomography angiography; IHD: Ischemic heart disease.