Higher noncalcified plaque burden and low-attenuation plaque burden on CCTA were significantly associated with more severe angina in women with ischemia and non-obstructive coronary arteries.
Cross-Sectional (n=109)
Yes
Is noncalcified and low-attenuation coronary plaque burden associated with angina severity in women with INOCA?
In women with INOCA, higher burdens of noncalcified and low-attenuation plaque on CCTA are associated with more severe angina, providing a potential pathophysiological basis for their symptoms.
Effect estimate: β -0.50
p-value: p=0.001
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 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. Severe narrowings of coronary arteries (i.e. the blood vessels that supply oxygenated blood to the heart), are the typical cause of chest pain in patients with atherosclerotic coronary artery disease. This type of chest pain is called angina. However, especially in women, angina can occur even if no major narrowings of coronary arteries are found using scans of the heart. We used artificial intelligence-assisted non-invasive imaging of coronary arteries to find out what aspects of this non-obstructive coronary atherosclerosis is associated with symptom severity in women without obvious artery narrowing. We observed that coronary plaques, which are buildups of fats and other substances in the artery walls, have a different composition in women with more severe angina. This information expands our understanding of why angina occurs in such patients and provides a rationale for possibly treating these women using anti-atherosclerotic drugs in the future. Wolny et al. evaluate the relationship between coronary atherosclerotic plaque composition quantified from computed tomography and symptoms in women with ischemia and non-obstructive coronary artery disease. Greater total plaque burden and high-risk plaque phenotypes are related to more frequent angina in this population.
Wolny et al. (Thu,) conducted a cross-sectional in Ischemia with non-obstructive coronary arteries (INOCA) (n=109). Noncalcified plaque (NCP) burden was evaluated on Seattle Angina Questionnaire (SAQ) score (β -0.50, p=0.001). Higher noncalcified plaque burden and low-attenuation plaque burden on CCTA were significantly associated with more severe angina in women with ischemia and non-obstructive coronary arteries.