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QUIET WARRIOR - Rationale and design: An ancillary study to the Women's IschemiA TRial to Reduce Events in
Osama Dasa1, Eileen Handberg1, Damini Dey2
1Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, United States of America.
Insights
This study investigates Ischemia with No Obstructive Coronary Arteries (INOCA) in women, a condition often overlooked. Findings will improve risk prediction for major adverse cardiac events (MACE) in women with non-obstructive coronary artery disease (CAD).
Area of Science:
- Cardiology
- Medical Imaging
- Women's Health
Background:
- Cardiovascular disease, particularly ischemic heart disease (IHD), is a leading cause of death in US women.
- Women with IHD often present with atypical symptoms, leading to delayed diagnosis and treatment.
- Many women experience major adverse cardiac events (MACE) despite having non-obstructive coronary artery disease (CAD) on standard angiography.
Purpose of the Study:
- To analyze Coronary Computed Tomography Angiography (CCTA) data and biorepository samples from the WARRIOR trial.
- To improve predictive tools for adverse outcomes in women with Ischemia with No Obstructive Coronary Arteries (INOCA).
- To uncover pathophysiological mechanisms underlying angina and MACE in women with INOCA.
Main Methods:
- Analysis of CCTA images from 600 WARRIOR participants.
- Assessment of clinical, social, and coronary artery variables, including plaque characteristics and inflammatory markers.
- Utilization of advanced imaging and machine learning to quantify plaque features and predict outcomes.
Main Results:
- Elucidation of associations between CCTA-derived plaque characteristics, ischemic symptoms, and MACE.
- Identification of correlations between specific plaque attributes and angina severity.
- Novel insights into the role of inflammatory markers and socioeconomic factors in cardiovascular risk.
Conclusions:
- The QUIET WARRIOR sub-study enhances understanding of INOCA in women.
- Integration of clinical, imaging, and socioeconomic data improves risk prediction for personalized therapy.
- This research addresses critical gaps in non-obstructive CAD management, promoting equitable cardiovascular care.
Background:
Cardiovascular disease is the leading cause of death among women in the US, predominantly due to ischemic heart disease (IHD). There is a notable deficiency in therapies tailored for IHD in women, who often present with variable symptoms that delay diagnosis and treatment. In many cases, coronary angiography does not reveal obstructive coronary artery disease (CAD) despite increased risk for major adverse cardiac events (MACE) compared with sex and age-matched asymptomatic cohorts.
Objectives:
The Women's IschemiA TRial to Reduce Events in Nonobstructive CAD (WARRIOR) evaluates intensive medical treatment for women with Ischemia with No Obstructive Coronary Arteries (INOCA). The QUIET WARRIOR sub-study aims to improve predictive tools for adverse outcomes by detailed analysis of Coronary Computed Tomography Angiography (CCTA) data and biorepository samples. These data will also uncover pathophysiological mechanisms associated with angina and MACE, improving predictive tools for symptomatic women with INOCA.
Methods:
This ancillary study will analyze CCTA images from 600 WARRIOR subjects. It will assess clinical, social, and coronary artery variables, including plaque characteristics and markers of inflammation. Advanced imaging techniques and machine-learning models will be employed to quantify plaque features and predict clinical outcomes.
Expected Results:
The study aims to elucidate associations between CCTA-derived plaque characteristics, ischemic symptoms, and MACE. Anticipated findings include correlations of specific plaque attributes with angina severity and novel insights into inflammatory markers. Socioeconomic variables will also be examined for their impact on cardiovascular risk.
Conclusion:
The QUIET WARRIOR sub-study will advance the understanding of INOCA in women, integrating clinical, imaging, and socioeconomic data to enhance risk prediction and guide personalized therapeutic strategies. This research will address critical gaps in managing nonobstructive CAD, promoting more equitable cardiovascular care.
