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Background <p>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&lt;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).</p> Methods <p>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.</p> Results <p>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, <i>p</i> = 0.015), have higher total cholesterol (195 vs 165 mg/dL, <i>p</i> = 0.006), but less frequently receive statins (31.8 vs 64.4%, <i>p</i> = 0.006) compared with patients with SAQ &gt; 60. Patients with SAQ ≤ 60 have higher total plaque (33.3 vs 24.3%, <i>p</i> = 0.001), and NCP burden (33.3 vs. 23.2%, <i>p</i> = 0.00065), and lower CP burden (0.0 vs. 0.3%, <i>p</i> = 0.005) compared with patients with SAQ &gt; 60. On multivariable linear regression adjusted for risk factors, higher NCP burden (β = −0.50, <i>p</i> = 0.001), LAP burden (β = −4.50, <i>p</i> = 0.008) and ML-IRS (β = −3.09, <i>p</i> = 0.04) are associated with lower SAQ score, i.e. more severe angina.</p> Conclusions <p>In women with INOCA, high-risk atherosclerotic plaque phenotypes are related to more severe angina.</p> <p></p>

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Artificial intelligence-enabled plaque characterization from coronary computed tomography establishes basis of angina in women with nonobstructive atherosclerosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月28日

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  • 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

摘要

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.