Altered limbic and autonomic processing supports brain-heart axis in Takotsubo syndrome. (5th March 2019)

• Record Type: Journal Article
• Authors: Templin, Christian; Hänggi, Jürgen; Klein, Carina; Topka, Marlene S; Hiestand, Thierry; Levinson, Rena A; Jurisic, Stjepan; Lüscher, Thomas F; Ghadri, Jelena-Rima; Jäncke, Lutz
• Is Part Of: European heart journal. Volume 40:Number 15(2019)
• Page Start: 1183
• Page End: 1187
• Publication Date: 2019-03-05
• Subjects: Brain–heart connection -- Takotsubo syndrome -- Autonomic-limbic integration -- Parasympathetic -- Sympathetic -- Resting state fMRI; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehz068
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction often triggered by emotional or physical stress. Severe activation of the sympathetic nervous system with catecholamine release caused by a dysfunctional limbic system has been proposed as a potential mechanism. We hypothesize that brain regions responsible for autonomic integration and/or limbic processing might be involved in the development of TTS. Here, we investigated alterations in resting state functional connectivity in TTS patients compared with healthy controls. Methods and results: Using brain functional magnetic resonance imaging (fMRI), resting state functional connectivity has been assessed in 15 subjects with TTS and 39 healthy controls. Network-based statistical analyses were conducted to identify subnetworks with altered resting state functional connectivity. Sympathetic and parasympathetic networks have been constructed in addition to the default mode network and whole-brain network. We found parasympathetic- and sympathetic-associated subnetworks both showing reduced resting state functional connectivity in TTS patients compared with controls. Important brain regions constituting parasympathetic- and sympathetic-associated subnetworks included the amygdala, hippocampus, and insula as well as cingulate, parietal, temporal, and cerebellar regions. Additionally, the default mode network as well as limbic regions in the whole-brain analysis demonstrated reduced resting state functional connectivity in TTS, including the hippocampus, parahippocampal, and medial prefrontal regions. Conclusion: For the first time, we demonstrate hypoconnectivity of central brain regions associated with autonomic functions and regulation of the limbic system in patients with TTS. These findings suggest that autonomic-limbic integration might play an important role in the pathophysiology and contribute to the understanding of TTS.