Artificial intelligence-enabled plaque characterization from coronary computed tomography establishes basis of angina in women with nonobstructive atherosclerosis.
Authors
Affiliations (13)
Affiliations (13)
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland.
- Biomedical Imaging Research Institute, Departments of Biomedical Sciences and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA.
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
- Smidt Heart Institute, and the Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
- Biostatistics Shared Resource, Department of Computational Biomedicine, Cedars Sinai Medical Center, Los Angeles, CA, USA.
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA.
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA.
- Blavatnik Family Women's Health Institute, Mount Sinai School of Medicine, New York, NY, USA.
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Division of Cardiology, Mayo Clinic Arizona, Phoenix, AZ, USA.
- Biomedical Imaging Research Institute, Departments of Biomedical Sciences and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA. [email protected].
Abstract
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). 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. 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. In women with INOCA, high-risk atherosclerotic plaque phenotypes are related to more severe angina.