Heart-brain microvascular MRI study: protocol for a multicentre, observational, cohort study in the UK assessing associations between small vessel disease of the heart and brain

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.