Related Experiment Video
Updated: Aug 23, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Coronary microvascular dysfunction is associated with impaired cognitive function: the Cerebral-Coronary Connection
Hernan Mejia-Renteria1, Alejandro Travieso1, Jordi A Matías-Guiu2
1Interventional Cardiology Unit, Hospital Clinico San Carlos IdISSC, Universidad Complutense de Madrid, c/ Profesor Martín Lagos, s/n. 28240 Madrid, Spain.
Insights
Coronary microcirculatory dysfunction is common in coronary artery disease patients and linked to brain small vessel disease and cognitive decline, suggesting a shared microvascular pathology.
Area of Science:
- Cardiology
- Neurology
- Vascular Biology
Background:
- Coronary microcirculatory dysfunction (CMD) and cerebral small vessel disease (CSVD) are distinct conditions.
- The relationship between CMD and CSVD, particularly in patients with coronary artery disease (CAD), remains unclear.
Purpose of the Study:
- To investigate the prevalence of CMD in patients with CAD.
- To assess the association between CMD, CSVD, and cognitive function in these patients.
Main Methods:
- Prospective blinded study (C3) involving 67 CAD patients.
- Physiological assessment of coronary microcirculation (coronary flow reserve - CFR).
- Brain MRI, transcranial Doppler (TCD), and neurocognitive testing.
Main Results:
- 55.2% of patients had abnormal CFR (<2.0).
- Low CFR correlated with increased white-matter hyperintensities, reduced grey matter volume, and white-matter microstructural damage.
- Low CFR was also associated with abnormal cerebral flow (TCD) and poorer cognitive test performance.
Conclusions:
- CMD is prevalent in CAD patients and is associated with CSVD, impaired cerebral hemodynamics, and cognitive impairment.
- These findings support a unified pathological process of microvascular dysfunction in both the heart and brain in CAD patients.
Background:
It remains unknown whether the presence of coronary microcirculatory dysfunction (CMD) correlates with its equivalent condition in the brain, cerebral small vessel disease (CSVD). The cerebral-coronary connection (C3), a prospective blinded study, investigated the prevalence of CMD in patients with coronary artery disease (CAD) and its association with CSVD and cognitive function.
Methods And Results:
Patients with documented CAD fulfilling inclusion criteria underwent physiological assessment of epicardial vessels and the microcirculation using intracoronary pressure and Doppler. Coronary microcirculation-related indices included coronary flow reserve (CFR) and hyperaemic microvascular resistance. Brain magnetic resonance imaging, transcranial Doppler (TCD), and neurocognitive examination were performed. Overall, 67 patients were included in the study (mean age 66 years, 73% female). Patients with abnormal CFR (<2.0) (55.2%) showed higher burden of white-matter hyperintensities: 43.2 vs. 20.0% (P = 0.044). After statistical adjustment, low CFR was associated with lower grey matter volume (P = 0.024) and with parameters of white-matter microstructural damage in diffusion-tensor imaging (lower fractional anisotropy and higher mean diffusivity, P = 0.029 and P = 0.032, respectively). Low CFR was associated with higher resistive (P = 0.027) and pulsatility (P = 0.043) values on TCD, and worse neurocognitive test scores (lower mini mental state examination, P = 0.025, and slower Trail Making Test A, P = 0.034).
Conclusions:
Coronary microcirculatory dysfunction is frequent in patients with CAD and correlates with CSVD, abnormal cerebral flow haemodynamics, and significant cognitive impairment. These findings support the hypothesis that microvascular dysfunction in the heart and the brain are part of a single pathological process affecting microcirculation in patients with CAD.
Clinical Trial Registration:
ClinicalTrials.gov NCT04131075.
More Related Videos
08:35Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
05:12A Mouse Model for Vascular Cognitive Impairment and Dementia Based on Needle-guided Asymmetric Bilateral Common Carotid Artery Stenosis
Published on: November 22, 2024
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Coronary Artery Disease III: Clinical Manifestations
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...