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Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Heart-brain microvascular MRI study: protocol for a multicentre, observational, cohort study in the UK assessing
Conor Patrick Bradley1,2, Vanessa Orchard2, Robert A Sykes3,4
1British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Insights
This study investigates the link between heart and brain small vessel diseases in patients with angina. Findings highlight associations between coronary microvascular dysfunction, cerebral small vessel disease, and cognitive function.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Medical Imaging
Background:
- Ischaemic heart disease (IHD) and cerebrovascular disease are major global health burdens.
- Cerebral small vessel disease (CSVD) is a primary cause of stroke and dementia.
- Coronary microvascular dysfunction contributes to angina and adverse outcomes, sharing risk factors with CSVD.
Purpose of the Study:
- To investigate the association between coronary microvascular dysfunction and cerebral small vessel disease (CSVD).
- To assess the prevalence of CSVD in patients with angina and no obstructive coronary artery disease.
- To evaluate the relationship between CSVD and cognitive function.
Main Methods:
- Prospective, observational, multicentre cohort study nested within the CorCMR trial.
- Enrolled patients with anginal symptoms and no obstructive coronary artery disease.
- Utilized brain MRI for CSVD detection and cardiac MRI for coronary microvascular dysfunction assessment, alongside neurocognitive testing.
Main Results:
- Prevalence of CSVD features in patients with angina and non-obstructive coronary artery disease was assessed.
- The association between coronary microvascular dysfunction and CSVD was evaluated.
- The relationship between CSVD and cognitive impairment was examined.
Conclusions:
- The CorCMR brain imaging study provides insights into the link between small vessel disease in the heart and brain.
- Findings contribute to understanding the shared pathophysiology and clinical significance of these conditions.
- The study addresses an evidence gap in demonstrating the relationship between coronary and cerebral small vessel disease.
Introduction:
Ischaemic heart disease (IHD) and cerebrovascular disease are leading causes of morbidity and mortality worldwide. Cerebral small vessel disease (CSVD) is a leading cause of dementia and stroke. While coronary small vessel disease (coronary microvascular dysfunction) causes microvascular angina and is associated with increased morbidity and mortality. The vascular anatomy of the heart and brain is similar with conduit arteries distributed over the surface of these organs which in turn branch into a network of microscopic penetrating arteries which provide organ perfusion via an end-organ microcirculation. It has also been demonstrated that coronary microvascular dysfunction and CSVD share common vascular risk factors and pathophysiological mechanisms of disease. This has led to a link between the conditions being hypothesised, however, there is an evidence gap clearly demonstrating this relationship. The CorCMR (coronary microvascular angina cardiovascular magnetic resonance imaging) brain imaging study will provide novel insights into the associations between small vessel disease of the heart and brain and related clinical significance.
Methods And Analysis:
The CorCMR brain imaging study is a prospective, observational, multicentre cohort study including a blinded, central analysis and independent clinical trials unit; a prespecified study nested within the CorCMR trial. We will enrol patients with anginal symptoms who have undergone invasive coronary angiography which has demonstrated no obstructive coronary artery disease. The participants will then undergo brain MRI (to detect CSVD) immediately followed by a quantitative stress perfusion cardiac MRI (to detect coronary microvascular dysfunction). Participants will also undergo neurocognitive testing. The objectives of the study are to assess the prevalence of MRI features of CSVD in patients with angina and no obstructive coronary artery disease; to assess the association between coronary microvascular dysfunction and CSVD and to assess the association between CSVD and cognition.
Ethics And Dissemination:
The CorCMR study is approved by the UK National Research Ethics Service (Reference 20/WS/0159). Findings will be disseminated through peer-reviewed publications. All patients provided written informed consent.
Trial Registration Number:
ClinicalTrials.gov ID NCT04805814.
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