Artificial intelligence-enabled plaque characterization from coronary computed tomography establishes basis of angina in women with nonobstructive atherosclerosis
Year: 2026
Type: article
Abstract: BACKGROUND: Half of women with ischemic symptoms have non-obstructive coronary artery disease (CAD), while the pathophysiology of their condition has not been characterized. Noncalcified (NCP) and low-attenuation plaque (CT density<30 Hounsfield units, LAP) burden quantified from coronary computed tomography angiography (CCTA) is associated with ischemia in patients with obstructive CAD. We hypothesize that NCP burden is related to angina in women with ischemic symptoms and Non-Obstructive Coronary Arteries (INOCA). METHODS: Women with INOCA enrolled in the WARRIOR trial were evaluated for angina severity with Seattle Angina Questionnaire (SAQ) at study entry. Baseline CCTA of 117 women were quantitatively analyzed with AI-based software for NCP, LAP and calcified plaque (CP) volumes and burdens (%, normalized to vessel volume) across the coronary tree. Machine-learning ischemia risk score (ML-IRS) integrating quantitative lumen and plaque features from CCTA was automatically measured. RESULTS: Among 109 women with visible plaque on CCTA (age 61.9, SD 10.3 years) median total plaque burden is 26.6% (IQR 18.6,32.0) and median SAQ score is 61.4 (IQR 54.6,69.1). Patients with more severe angina (SAQ ≤ 60) are younger (58.1 vs 62.0 years, p = 0.015), have higher total cholesterol (195 vs 165 mg/dL, p = 0.006), but less frequently receive statins (31.8 vs 64.4%, p = 0.006) compared with patients with SAQ > 60. Patients with SAQ ≤ 60 have higher total plaque (33.3 vs 24.3%, p = 0.001), and NCP burden (33.3 vs. 23.2%, p = 0.00065), and lower CP burden (0.0 vs. 0.3%, p = 0.005) compared with patients with SAQ > 60. On multivariable linear regression adjusted for risk factors, higher NCP burden (β = -0.50, p = 0.001), LAP burden (β = -4.50, p = 0.008) and ML-IRS (β = -3.09, p = 0.04) are associated with lower SAQ score, i.e. more severe angina. CONCLUSIONS: In women with INOCA, high-risk atherosclerotic plaque phenotypes are related to more severe angina.
Source: Communications Medicine
Authors: Rafal Wolny, Guadalupe Flores Tomasino, Kajetan Grodecki, Joel Lenell, Caroline Park, Rebekah Park, Jacek Kwiecinski, Osama Dasa, Vinicius Calsavara, Daniel S. Berman, Piotr J. Slomka, Matthew J. Budoff, Eileen Handberg, Carl J. Pepine, Leslee J. Shaw, Janet Wei, Martha Gulati, C. Noel Bairey Merz, Balaji Tamarappoo, Damini Dey
Institutions: Cedars-Sinai Medical Center, Institute of Cardiology, Medical University of Warsaw, Cedars-Sinai Smidt Heart Institute, University of Florida Health, University of Florida, University of California, Los Angeles, Harbor–UCLA Medical Center, Icahn School of Medicine at Mount Sinai, Mayo Clinic in Arizona, Mayo Clinic Hospital
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,690
Awards: G4893300499, Effect of Intensive Medical Treatment on Quantified Coronary Artery Plaque Components with Serial Coronary CTA in Women with Non-Obstructive CAD, Integrated prediction of cardiovascular events by automated coronary plaque and pericoronary adipose tissue quantification from CT Angiography, Women's Ischemia Trial to Reduce Events in Non-Obstructive CAD (WARRIOR)
OpenAlex ID: W7162684364