Key result
Patients with MVA showed higher body pain (p=0.046) and mental health scores (p=0.039) than AMI patients, while TTS patients exhibited the strongest functional connectivity between CAN nodes (p=0.005).
Why the study?
Dysfunctional resting central autonomic network may drive aberrant responses to psychosocial stressors, and it was hypothesized that patients with primary microvascular angina or Takotsubo syndrome exhibit distinctive central autonomic functional organization associated with psychological patterns.
Do patients with primary microvascular angina or Takotsubo syndrome exhibit altered central autonomic nervous system functional organization and psychosocial patterns compared to patients with previous myocardial infarction?
Observational (n=50)
Do patients with primary microvascular angina or Takotsubo syndrome exhibit altered central autonomic nervous system functional organization and psychosocial patterns compared to patients with previous myocardial infarction?
Patients with MVA exhibit psychosocial patterns suggestive of somatization, while those with Takotsubo syndrome show increased functional integration in brain areas involved in interoceptive pain awareness and negative emotions.
Answers are grounded in this paper and cite their sources.
May indicate unique psychosocial and neural profiles in MVA and TTS; hypothesis-generating for central mechanisms, should not yet change practice.
INTRODUCTION AND OBJECTIVE: Dysfunctional central autonomic nervous system network (CAN) at rest may result in aberrant autonomic responses to psychosocial stressors. We hypothesised that patients with primary microvascular angina (MVA) or Takotsubo syndrome (TTS) would exhibit a peculiar functional organisation of the CAN, potentially associated with psychological patterns. METHODS: Patients underwent a psychosocial evaluation: a clinical diagnostic interview, Millon Clinical Multiaxial Inventory III, State-Trait Anxiety Inventory form Y and Short Form 36 Health Survey (SF-36). The strength of intrinsic functional connectivity (FC) between various nodes of the CAN was investigated using cerebral resting state functional MRI (RS-fMRI). RESULTS: We evaluated 50 (46 women) stable patients: 16 patients with MVA, 17 patients with TTS and 17 patients with previous acute myocardial infarction (AMI). Compared with AMI, patients with MVA showed a lower (higher impairment) SF-36 Body-Pain score (p 0.046) and a higher SF-36 Mental-Health score (p 0.039). Patients with TTS showed the strongest FC between two nodes of the CAN (sympathetic midcingulate cortex and parasympathetic primary motor area) (F 6.25, p 0.005) using RS-fMRI. CONCLUSIONS: The study implements an innovative collaborative research among cardiologists, neuroscientists and psychiatrists ('Neuro-psycho-heart Team'). MVA showed a discrepancy between the highest level of self-reported body pain and the best mental health score, which might suggest a mechanism of somatisation. TTS exhibited an increased functional integration between two areas of the CAN involved in interoceptive pain awareness and negative emotional status. We implemented an innovative research collaboration among cardiologists, neuroscientists and psychiatrists. These data are hypothesis generating and suggest potential prospective investigations on pathophysiology and implementation of psychotherapy and stress-reducing techniques as therapeutic strategies. TRIAL REGISTRATION NUMBER: NCT02759341.
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Cattaneo et al. (2020) conducted an observational in Primary microvascular angina and Takotsubo syndrome (n=50). Primary microvascular angina or Takotsubo syndrome vs. Previous acute myocardial infarction was evaluated on SF-36 scores and intrinsic functional connectivity (FC) on RS-fMRI (p=0.005). Patients with MVA showed higher body pain (p=0.046) and mental health scores (p=0.039) than AMI patients, while TTS patients exhibited the strongest functional connectivity between CAN nodes (p=0.005).
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