QUIET WARRIOR – Rationale and design: An ancillary study to the Women's IschemiA TRial to Reduce Events in Nonobstructive CAD (WARRIOR)
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,...
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| Format: | Article |
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Elsevier
2025-03-01
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| Series: | American Heart Journal Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602225000114 |
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| author | Osama Dasa Eileen Handberg Damini Dey Pinaki Sarder Margaret C. Lo Balaji K. Tamarappoo Steven M. Smith Leslee J. Shaw C. Noel Bairey Merz Carl J. Pepine |
| author_facet | Osama Dasa Eileen Handberg Damini Dey Pinaki Sarder Margaret C. Lo Balaji K. Tamarappoo Steven M. Smith Leslee J. Shaw C. Noel Bairey Merz Carl J. Pepine |
| author_sort | Osama Dasa |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-8d3c8ecf59714675952e4f14f139662c |
| institution | Kabale University |
| issn | 2666-6022 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Heart Journal Plus |
| spelling | doaj-art-8d3c8ecf59714675952e4f14f139662c2025-02-07T04:48:24ZengElsevierAmerican Heart Journal Plus2666-60222025-03-0151100508QUIET WARRIOR – Rationale and design: An ancillary study to the Women's IschemiA TRial to Reduce Events in Nonobstructive CAD (WARRIOR)Osama Dasa0Eileen Handberg1Damini Dey2Pinaki Sarder3Margaret C. Lo4Balaji K. Tamarappoo5Steven M. Smith6Leslee J. Shaw7C. Noel Bairey Merz8Carl J. Pepine9Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, United States of America; Corresponding author at: Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Box 100238, Gainesville, FL 32610-0238, United States of America.Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, United States of AmericaBiomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of AmericaQuantitative Health, Departments of Medicine, Electrical and Computer Engineering, Biomedical Engineering, and Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States of AmericaDivision of General Internal Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, United States of AmericaHeart Institute, Banner University Medical Center, Phoenix, AR, United States of AmericaDivision of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, United States of America; Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States of AmericaDivision of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of AmericaBarbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of AmericaDivision of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, United States of AmericaBackground: 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.http://www.sciencedirect.com/science/article/pii/S2666602225000114Coronary computed tomography angiography (CCTA)Artificial intelligence (AI)Ischemia and No Obstructive Coronary Arteries (INOCA)Non-obstructive coronary artery disease (CAD)Microvascular dysfunctionMajor adverse cardiac events (MACE) |
| spellingShingle | Osama Dasa Eileen Handberg Damini Dey Pinaki Sarder Margaret C. Lo Balaji K. Tamarappoo Steven M. Smith Leslee J. Shaw C. Noel Bairey Merz Carl J. Pepine QUIET WARRIOR – Rationale and design: An ancillary study to the Women's IschemiA TRial to Reduce Events in Nonobstructive CAD (WARRIOR) American Heart Journal Plus Coronary computed tomography angiography (CCTA) Artificial intelligence (AI) Ischemia and No Obstructive Coronary Arteries (INOCA) Non-obstructive coronary artery disease (CAD) Microvascular dysfunction Major adverse cardiac events (MACE) |
| title | QUIET WARRIOR – Rationale and design: An ancillary study to the Women's IschemiA TRial to Reduce Events in Nonobstructive CAD (WARRIOR) |
| title_full | QUIET WARRIOR – Rationale and design: An ancillary study to the Women's IschemiA TRial to Reduce Events in Nonobstructive CAD (WARRIOR) |
| title_fullStr | QUIET WARRIOR – Rationale and design: An ancillary study to the Women's IschemiA TRial to Reduce Events in Nonobstructive CAD (WARRIOR) |
| title_full_unstemmed | QUIET WARRIOR – Rationale and design: An ancillary study to the Women's IschemiA TRial to Reduce Events in Nonobstructive CAD (WARRIOR) |
| title_short | QUIET WARRIOR – Rationale and design: An ancillary study to the Women's IschemiA TRial to Reduce Events in Nonobstructive CAD (WARRIOR) |
| title_sort | quiet warrior rationale and design an ancillary study to the women s ischemia trial to reduce events in nonobstructive cad warrior |
| topic | Coronary computed tomography angiography (CCTA) Artificial intelligence (AI) Ischemia and No Obstructive Coronary Arteries (INOCA) Non-obstructive coronary artery disease (CAD) Microvascular dysfunction Major adverse cardiac events (MACE) |
| url | http://www.sciencedirect.com/science/article/pii/S2666602225000114 |
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