Imaging the Heart Brain Interaction in Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA)

Abstract

Introduction
Patients presenting with a suspected myocardial infarction but who have
normal coronary arteries at angiography (MINOCA) are a common clinical
challenge. There is early evidence for a heart-brain link in several cardiac
pathologies, including takotsubo syndrome (TS), which partly makes up the
MINOCA population. The pathophysiological association of the heart-brain
interaction in the wider MINOCA population has not been studied.
Methods
In this single centre, prospective, longitudinal observational study, all
patients who presented with a suspected myocardial infarction and nonobstructive coronary arteries on invasive angiography were approached. Age and
sex matched patients with a ST elevation myocardial infarction (STEMI) and a
group of healthy volunteers were control groups. Patients received routine care
but underwent additional psychological questionnaires and cardiac and functional
brain magnetic resonance imaging within 14 days of admission and at 6 months.
Image pre-processing and analysis was undertaken in a blinded fashion.
Results
72 participants, 27 STEMI controls and 28 healthy controls were recruited.
There were widespread reductions in brain grey matter volume compared to
healthy controls, but no differences compared to STEMI controls. These
reductions largely normalised at follow up. There was reduced connectivity in the
central executive network and default mode network compared to healthy
controls in the acute phase, and these changes largely persisted at follow up.
There were less extensive differences compared with STEMI patients. There were
negative relationships between global brain efficiency, connectivity and measures
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of anxiety and stress in the MINOCA population which may partly explain these
findings.
Conclusion
MINOCA patients have high levels of stress and anxiety at presentation
and have dynamic anatomical and functional disruption in mainly limbic and
autonomic brain networks. There are correlations between stress and anxiety
scores and reduced connectivity and reduced global brain efficiency which may
partly explain these findings. Further larger studies are needed in this area and in
the wider myocardial infarction population as there may be potentially important
implications for the follow up and management of these patients which requires
investigation.

Date of Award	24 Jan 2023
Original language	English
Awarding Institution	University of Bristol
Supervisor	Elanor C Hinton (Supervisor), Chiara Bucciarelli-Ducci (Supervisor) & Angus K Nightingale (Supervisor)