Bradley Conor Patrick, Orchard Vanessa, Sykes Robert A, McKinley Gemma, McConnachie Alex, Donnelly Paul, Watt Jodi, Kellman Peter, Quinn Terry, Fullerton Natasha, Berry Colin
British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Golden Jubilee National Hospital, West of Scotland Regional Heart and Lung Centre, Glasgow, UK.
BMJ Open. 2024 Dec 20;14(12):e088372. doi: 10.1136/bmjopen-2024-088372.
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.
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.
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.
ClinicalTrials.gov ID NCT04805814.
缺血性心脏病（IHD）和脑血管疾病是全球发病和死亡的主要原因。脑小血管疾病（CSVD）是痴呆和中风的主要原因。而冠状动脉小血管疾病（冠状动脉微血管功能障碍）会导致微血管性心绞痛，并与发病率和死亡率增加相关。心脏和大脑的血管解剖结构相似，导管动脉分布在这些器官的表面，进而分支成一个微观穿透动脉网络，通过终末器官微循环为器官提供灌注。研究还表明，冠状动脉微血管功能障碍和CSVD具有共同的血管危险因素和疾病病理生理机制。这导致人们推测这两种疾病之间存在联系，然而，目前尚缺乏明确证明这种关系的证据。CorCMR（冠状动脉微血管性心绞痛心血管磁共振成像）脑成像研究将为心脏和大脑小血管疾病之间的关联及其相关临床意义提供新的见解。
CorCMR脑成像研究是一项前瞻性、观察性、多中心队列研究，包括盲法、中心分析和独立临床试验单位；这是一项预先设定的嵌套在CorCMR试验中的研究。我们将招募有胸痛症状且已接受侵入性冠状动脉造影显示无阻塞性冠状动脉疾病的患者。参与者随后将立即接受脑部MRI（以检测CSVD），紧接着进行定量负荷灌注心脏MRI（以检测冠状动脉微血管功能障碍）。参与者还将接受神经认知测试。该研究的目的是评估有胸痛且无阻塞性冠状动脉疾病患者中CSVD的MRI特征的患病率；评估冠状动脉微血管功能障碍与CSVD之间的关联，并评估CSVD与认知之间的关联。
CorCMR研究已获得英国国家研究伦理服务机构批准（参考编号20/WS/0159）。研究结果将通过同行评审出版物进行传播。所有患者均提供了书面知情同意书。
ClinicalTrials.gov标识符NCT04805814。
