Evidence map›Paper›PMID 42209864›Full record

ArticleCommunications medicine2026

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

Rafal Wolny, Guadalupe Flores Tomasino, Kajetan Grodecki, Joel Lenell, Caroline Park, Rebekah Park, Jacek Kwiecinski, Osama Dasa, Vinicius Calsavara, Daniel S Berman and 10 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Communications medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Rafal WolnyDepartment of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland.ORCID http://orcid.org/0000-0001-9661-7563
Guadalupe Flores TomasinoBiomedical Imaging Research Institute, Departments of Biomedical Sciences and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA.ORCID http://orcid.org/0000-0002-5615-7280
Kajetan GrodeckiBiomedical Imaging Research Institute, Departments of Biomedical Sciences and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA.
Joel LenellBiomedical Imaging Research Institute, Departments of Biomedical Sciences and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA.ORCID http://orcid.org/0000-0002-7885-962X
Caroline ParkBiomedical Imaging Research Institute, Departments of Biomedical Sciences and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA.ORCID http://orcid.org/0000-0001-9930-073X
Rebekah ParkSmidt Heart Institute, and the Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.ORCID http://orcid.org/0009-0006-0179-6604
Jacek KwiecinskiDepartment of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland.
Osama DasaDivision of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
Vinicius CalsavaraBiostatistics Shared Resource, Department of Computational Biomedicine, Cedars Sinai Medical Center, Los Angeles, CA, USA.
Daniel S BermanSmidt Heart Institute, and the Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.ORCID http://orcid.org/0000-0002-3793-9578
Piotr J SlomkaDivision of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.ORCID http://orcid.org/0000-0002-6110-938X
Matthew J BudoffLundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA.ORCID http://orcid.org/0000-0002-9616-1946
Eileen HandbergDivision of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
Carl J PepineDivision of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA.ORCID http://orcid.org/0000-0002-6011-681X
Leslee J ShawBlavatnik Family Women's Health Institute, Mount Sinai School of Medicine, New York, NY, USA.
Janet WeiBarbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Martha GulatiBarbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
C Noel Bairey MerzBarbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Balaji Tamarappoo *Division of Cardiology, Mayo Clinic Arizona, Phoenix, AZ, USA.
Damini Dey *Biomedical Imaging Research Institute, Departments of Biomedical Sciences and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA. Damini.Dey@csmc.edu.

Funding

Integrated prediction of cardiovascular events by automated coronary plaque and pericoronary adipose tissue quantification from CT AngiographyR01HL148787 · NHLBI · CEDARS-SINAI MEDICAL CENTER · PI DEY, DAMINI · 2020 to 2023
$3.0M
Effect of Intensive Medical Treatment on Quantified Coronary Artery Plaque Components with Serial Coronary CTA in Women with Non-Obstructive CADR01HL151266 · NHLBI · CEDARS-SINAI MEDICAL CENTER · PI DEY, DAMINI, TAMARAPPOO, BALAJI K. · 2020 to 2023
$1.6M
HSRD VA SDR 10-012NHLBI NIH HHS R01 HL148787NHLBI NIH HHS R01 HL151266U.S. Department of Health & Human Services | NIH | National Heart, Lung, and Blood Institute (NHLBI) 1R01HL148787U.S. Department of Health & Human Services | NIH | National Heart, Lung, and Blood Institute (NHLBI) R01HL151266
6 · The paper itself

Abstract

backgroundHalf 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).

methodsWomen 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.

resultsAmong 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.

conclusionsIn women with INOCA, high-risk atherosclerotic plaque phenotypes are related to more severe angina.

Identifiers

PMID42209864
PMCPMC13500560

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.