Advances in brain MRI for CAD-associated cognitive impairment with supplementary perspectives from traditional Chinese medicine

Coronary artery disease (CAD) and cognitive impairment (CI) are becoming more and more a public health challenge, and the heart-brain axis theory can describe their correlation. In this review, we highlight recent research and future directions for brain magnetic resonance imaging (MRI) based on CAD. Recent studies show that CAD damages the brain’s white matter microstructure, disrupts brain functional network connectivity, and causes gray matter atrophy through multiple pathological mechanisms, including chronic cerebral hypoperfusion, cerebral small vessel disease, neuroinflammation, and oxidative stress, which in turn cause cognitive decline. Recently, multimodal brain MRI has been used to assess damage to the heart-brain axis. Graph-theoretic analysis and artificial intelligence can be used to learn the relationships between abnormal brain network topology, cardiovascular risk phenotypes, and brain imaging features in CAD patients, and have been proven to be a promising biomarker. Notably, this review is the first to systematically explore brain MRI biomarkers as objective tools for validating the scientific basis of traditional Chinese medicine (TCM) heart-brain theory in CAD-related CI. By elucidating the convergence of TCM holistic concepts with modern neuroimaging, we provide a novel imaging assessment framework to guide the development of integrated TCM-Western medicine strategies for the synergistic treatment of heart and brain.