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Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
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Artificial intelligence-enabled plaque characterization from coronary computed tomography establishes basis of angina

Rafal Wolny1,2, Guadalupe Flores Tomasino2, Kajetan Grodecki2,3

  • 1Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland.

Communications Medicine
|May 28, 2026
PubMed

Insights

In women with non-obstructive coronary artery disease (INOCA), higher noncalcified plaque (NCP) burden is linked to more severe angina. This finding highlights the role of plaque characteristics in INOCA symptoms.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Atherosclerosis Research

Background:

  • Half of women experiencing ischemic symptoms have non-obstructive coronary artery disease (CAD), a condition whose pathophysiology remains poorly understood.
  • Noncalcified plaque (NCP) and low-attenuation plaque (LAP) burden, quantified via coronary computed tomography angiography (CCTA), are associated with ischemia in patients with obstructive CAD.
  • This study investigates the relationship between NCP burden and angina in women with INOCA.

Purpose of the Study:

  • To determine if noncalcified plaque burden is associated with angina severity in women diagnosed with INOCA.
  • To explore the role of atherosclerotic plaque characteristics in the manifestation of ischemic symptoms in women.

Main Methods:

  • The study analyzed baseline CCTA data from 117 women enrolled in the WARRIOR trial who had INOCA.
  • AI-based software quantified noncalcified plaque (NCP), low-attenuation plaque (LAP), and calcified plaque (CP) volumes and burdens.
  • Angina severity was assessed using the Seattle Angina Questionnaire (SAQ), and a machine-learning ischemia risk score (ML-IRS) was calculated.

Main Results:

  • Among 109 women with visible plaque, those with more severe angina (SAQ ≤ 60) were younger and had higher total cholesterol.
  • Patients with more severe angina exhibited higher total plaque and NCP burden, but lower calcified plaque (CP) burden.
  • Multivariable regression revealed that higher NCP burden, LAP burden, and ML-IRS were significantly associated with lower SAQ scores (indicating more severe angina).

Conclusions:

  • In women with INOCA, specific high-risk atherosclerotic plaque phenotypes, particularly noncalcified plaque, are significantly related to more severe angina symptoms.
  • These findings suggest that plaque characteristics play a crucial role in the pathophysiology of angina in women with INOCA.
Abstract

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