Spatiotemporal Dysfunction of Cardiac-driven Cortical Gradients in Coronary Artery Disease for Emotional Regulation

Depression and anxiety are highly prevalent among patients with coronary artery disease (CAD), suggesting direct interactions between cardiovascular pathology and brain function. However, the influence of cardiac modulation on neural activity remains poorly understood. Here, through simultaneous EEG-ECG recordings in healthy individuals and CAD patients, we characterize the spatiotemporal organization of heart-evoked potentials (HEPs) and their disease-related alterations. We identify a conserved anterior-posterior cortical gradient featuring prefrontal suppression and occipital enhancement that dynamically modulates across the cardiac cycle, attenuating before systole and peaking after the R-wave. Notably, while CAD patients preserve this overall gradient, they exhibit region-specific disturbances including prefrontal hypoactivation and parietal hyperactivation. These pathological changes in cardiac-driven cortical processing correlate with depressive and anxiety symptomatology. Our results provide a systematic framework for understanding how cardiovascular disease disrupts neurocardiac communication, potentially contributing to neuropsychiatric comorbidities in CADs.