ArticleClinical research in cardiology : official journal of the German Cardiac Society2020
Functional neuroimaging in the acute phase of Takotsubo syndrome: volumetric and functional changes of the right insular cortex.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
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25 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 citations in OpenAlex.
- The role of central autonomic nervous system dysfunction in Takotsubo syndrome: a systematic review.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2022Pooled it
- Neurocardiology: Brain-Heart Interactions in the Heart.MedComm · 2026Review
- Neuroimaging biomarkers of the brain-heart axis in Takotsubo syndrome: regional convergence without directional consistency: a systematic review and biomarker qualification appraisal.Acta neurologica Belgica · 2026Review
- Anxiety and Depression in Women's Cardiovascular Health: Risk Modifiers, Mechanisms and Clinical Implications.Journal of cardiovascular development and disease · 2026Review
- Bidirectional brain-heart interactions in health and disease.Nature reviews. Neurology · 2026Review
- Takotsubo Syndrome in 2025: Evolving Concepts in Pathophysiology, Diagnosis, and Long-Term Management.Journal of clinical medicine · 2025Review
- Takotsubo syndrome: Unraveling the mystery behind its triggers (Review).International journal of molecular medicine · 2025Review
- Takotsubo syndrome: cognitive behavioural therapy, physical training, and brain function recovery in the BREAKOUT trial.European heart journal · 2025Article
- When a Woman's Heart Fails to Contain: Takotsubo Syndrome as a Gendered Collapse of Emotional Regulation.Life (Basel, Switzerland) · 2025Review
- The brain-heart axis: integrative cooperation of neural, mechanical and biochemical pathways.Nature reviews. Cardiology · 2025Review
- A case of stress induced cardiomyopathy presenting during status epilepticus in a multiple sclerosis patient.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Article
- Combined Brain-Heart Imaging in Takotsubo Syndrome: Towards a Holistic Patient Assessment.Journal of clinical medicine · 2024Article
- Central stress pathways in the development of cardiovascular disease.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2024Review
- Triggers, characteristics, and hospital outcome of patients with Takotsubo syndrome: 10 years experience in a large university hospital centre.European heart journal supplements : journal of the European Society of Cardiology · 2023Article
- Takotsubo Syndrome: The Secret Crosstalk between Heart and Brain.Reviews in cardiovascular medicine · 2023Review
- Limbic Responses to Aversive Visual Stimuli during the Acute and Recovery Phase of Takotsubo Syndrome.Journal of clinical medicine · 2022Article
- The Impact of Mental Stress on Cardiovascular Health-Part II.Journal of clinical medicine · 2022Review
- Myocardial Ischemia in Patients with COVID-19 Infection: Between Pathophysiological Mechanisms and Electrocardiographic Findings.Life (Basel, Switzerland) · 2022Review
- The omnipresence of autonomic modulation in health and disease.Progress in neurobiology · 2022Review
- Sex Hormone-Specific Neuroanatomy of Takotsubo Syndrome: Is the Insular Cortex a Moderator?Biomolecules · 2022Review
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Authors and funding
11 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundA brain-heart interaction has been proposed in Takotsubo syndrome (TTS). Structural changes in the limbic system and hypoconnectivity between certain brain areas in the chronic phase of the disease have been reported, but little is known concerning functional neuroimaging in the acute phase. We hypothesized anatomical and functional changes in the central nervous system and investigated whole-brain volumetric and functional connectivity alterations in the acute phase TTS patients compared to controls.
methodsAnatomical and resting-state functional magnetic resonance imaging were performed in postmenopausal females: thirteen in the acute TTS phase and thirteen healthy controls without evidence of coronary artery disease. Voxel-based morphometry and graph theoretical analysis were applied to identify anatomical and functional differences between patients and controls.
resultsSignificantly lower gray matter volumes were found in TTS patients in the right middle frontal gyrus (p = 0.004) and right subcallosal cortex (p = 0.009) compared to healthy controls. When lower threshold was applied, volumetric changes were noted in the right insular cortex (p = 0.0113), the right paracingulate cortex (p = 0.012), left amygdala (p = 0.018), left central opercular cortex (p = 0.017), right (p = 0.013) and left thalamus (p = 0.017), and left cerebral cortex (p = 0.017). Graph analysis revealed significantly (p < 0.01) lower functional connectivity in TTS patients compared to healthy controls, particularly in the connections originating from the right insular cortex, temporal lobes, and precuneus.
conclusionIn the acute phase of TTS volumetric changes in frontal regions and the central autonomic network (i.e. insula, anterior cingulate cortex, and amygdala) were noted. In particular, the right insula, associated with sympathetic autonomic tone, had both volumetric and functional changes.
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