ArticleEuropean heart journal2021
Stress-associated neurobiological activity associates with the risk for and timing of subsequent Takotsubo syndrome.
Article in European heart journal, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 72 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Characterization of priMary And sEcondary STress Related takOtsubo: the MAESTRO Pilot Study
Impact of Cognitive Behavioral Therapy on Neural, Inflammatory, & Autonomic Markers in a Sample With PTSD and Cardiovascular Risk: Protocol for a Pilot Randomized Controlled Trial
Who cites it
72 citing papers in PubMed, 2 syntheses or guidelines pooled it, 109 citations in OpenAlex.
- The relation between stress-related neural activity assessed by brainEuropean journal of nuclear medicine and molecular imaging · 2025Pooled it
- 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
- Cardiovascular imaging with total-body PET.The British journal of radiology · 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
- Neural resilience improves survival in cardiovascular patients.Cardiovascular research · 2026Article
- Cardiac Sympathetic Nerve Terminals in the Pathogenesis of Takotsubo Syndrome: A Brief Review and Novel Analytical Approach.Reviews in cardiovascular medicine · 2026Review
- Coronary Microvascular Dysfunction in Stress Cardiomyopathy: At the Heart of the Problem.Life (Basel, Switzerland) · 2026Review
- Various Psychiatric Comorbidities and Smoking Appear to be Associated With Takotsubo Cardiomyopathy: A Nationwide Analysis From 2016 to 2022.Critical pathways in cardiology · 2026Observational
- Psychological and cognitive indicators of Takotsubo syndrome.Discover mental health · 2026Article
- Incidence of ischemic stroke in Takotsubo cardiomyopathy patients: a systematic review and meta-analysis.The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology · 2026Review
- Takotsubo syndrome: pathophysiological insights and innovations in patient care.Nature reviews. Cardiology · 2026Review
- Bidirectional brain-heart interactions in health and disease.Nature reviews. Neurology · 2026Review
- Brain-body interactions in systemic diseases: a survey from an imaging perspective.MedScience · 2026Review
- Recovery beyond ejection fraction after takotsubo syndrome: a multidimensional framework for risk-enriched follow-up.Frontiers in cardiovascular medicine · 2026Review
- Influence of Magnesium Status on the Association of Tobacco Exposure With Depression in Old Patients With Heart Failure: A Cross-Sectional Study of the NHANES Database.Cardiovascular therapeutics · 2026Article
- Depression and Anxiety Associate With Adverse Cardiovascular Events via Neural, Autonomic, and Inflammatory Pathways.Circulation. Cardiovascular imaging · 2026Article
- Heart-brain axis pathophysiological understanding and clinical impact.Frontiers in cardiovascular medicine · 2026Review
- Takotsubo Syndrome in 2025: Evolving Concepts in Pathophysiology, Diagnosis, and Long-Term Management.Journal of clinical medicine · 2025Review
- Stress and Acute Coronary Syndrome.Cardiology research · 2025Review
12 more citing papers are in PubMed but not listed here.
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Authors and funding
19 authors at 3 institutions in 2 countries.
Funding
Abstract
aimsActivity in the amygdala, a brain centre involved in the perception of and response to stressors, associates with: (i) heightened sympathetic nervous system and inflammatory output and (ii) risk of cardiovascular disease. We hypothesized that the amygdalar activity (AmygA) ratio is heightened among individuals who develop Takotsubo syndrome (TTS), a heart failure syndrome often triggered by acute stress. We tested the hypotheses that (i) heightened AmygA precedes development of TTS and (ii) those with the highest AmygA develop the syndrome earliest. METHODS AND
resultsIndividuals (N=104, median age 67.5 years, 72% female, 86% with malignancy) who underwent clinical 18 F-FDG-PET/CT imaging were retrospectively identified: 41 who subsequently developed TTS and 63 matched controls (median follow-up 2.5 years after imaging). AmygA was measured using validated methods. Individuals with (vs. without) subsequent TTS had higher baseline AmygA (P=0.038) after adjusting for TTS risk factors. Further, AmygA associated with the risk for subsequent TTS after adjustment for risk factors [standardized hazard ratio (95% confidence interval): 1.643 (1.189, 2.270), P=0.003]. Among the subset of individuals who developed TTS, those with the highest AmygA (>mean + 1 SD) developed TTS ∼2 years earlier after imaging vs. those with lower AmygA (P=0.028).
conclusionHigher AmygA associates with an increased risk for TTS among a retrospective population with a high rate of malignancy. This heightened neurobiological activity is present years before the onset of TTS and may impact the timing of the syndrome. Accordingly, heightened stress-associated neural activity may represent a therapeutic target to reduce stress-related diseases, including TTS.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.