Bidirectional regulation of brain–heart interaction: mechanisms and therapeutic advances

Background Brain–heart interaction is a bidirectional regulatory system integrating neural, biochemical, immune, and energy mechanisms. It plays a central role in maintaining homeostasis and is critically involved in brain–heart comorbidity. Methods: Emerging evidence has elucidated that the brain modulates cardiac rhythm, conduction, and contraction via the central autonomic network, while the heart reciprocally influences brain function, emotion, and cognition through vagal afferents, interoceptive pathways, and immune signaling. The newly proposed brain–heart–immune circuit further expands our understanding of diseases such as myocardial infarction and heart failure. Concurrently, technological innovations—including vagus nerve stimulation, transcranial magnetic stimulation, deep brain stimulation, and wireless self‑powered devices—are driving a paradigm shift from empirical intervention toward closed‑loop intelligent regulation.Results and Conclusion Future research should prioritize cross‑disciplinary integration, multimodal signal fusion, and individualized precision intervention, with the goal of advancing mechanism‑driven diagnosis and treatment of brain–heart comorbidity.