Imaging Links Stress Brain Activity and Plaque Instability i
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For the first time, researchers have prospectively demonstrated a mechanistic link between brain emotional activity and the heart in individuals with acute myocardial infarction (AMI).

On 18F-fluorodeoxyglucose (18F-FDG) PET/CT imaging performed on patients with AMI, they found that brain amygdalar activity(AmygA), carotid arterial inflammation(AI), and macrophage hematopoiesis(HEMA) were all concurrently enhanced and significantly more active than those in the control group.

AmygA, as a marker of emotional stress, also correlated well with psychologic measurements of chronic emotional stress and current depressive symptoms in patients with AMI.

"These results raise the possibility that stress-associated neurobiological activity is linked with acute plaque instability via augmented macrophage activity and could be a potential therapeutic target for plaque inflammation in AMI," said researchers from Korea University Guro Hospital, Seoul.
18F-FDG-PET/CT was performed within 45 days of AMI in 45 patients (mean age, 60 years) and in 17 age-matched control subjects.

The control group comprised individuals with no significant coronary artery disease enrolled from a pool of clinically stable patients undergoing diagnostic evaluation for anginal chest pain.

In 10 patients of the AMI group, repeat 18F-FDG-PET/CT imaging was performed after 6 months to study temporal changes. At this time point, amygdalar activity, carotid arterial inflammation, and bone marrow activity had fallen to levels comparable with control subjects.

Commenting on the study, the researchers said that the findings boost understanding of the brain–heart connection.
"This study extends prior findings in that they also showed an association between the heightened brain activity and the severity of the coronary disease. It's an interesting finding and it strengthens the overall set of associations between activity in the brain, especially the stress portions of the brain, and pathology in the coronary system," they added.

The researchers noted a few limitations of the current study, including a relatively long delay between the index event and the imaging study, during which time "the anti-inflammatory effects of drugs such as statins may have had an effect."

Further, the researchers didn't investigate cardiac inflammation at the site of the infarction, "which may have provided additional insights as to the direction of the observed associations," theyconclude. "Nevertheless, this study underlines the potential value of multisystem 18F-FDG-PET imaging as a method for interrogating the association of atherosclerotic inflammation with activity in other organ systems."