Key result
Prior Takotsubo syndrome is linked to increased central autonomic connectivity at rest and during stress.
Why the study?
The central autonomic nervous system is believed to play a role in Takotsubo syndrome, but patterns of brain functional connectivity in these patients remain to be investigated.
Does a previous episode of Takotsubo syndrome alter brain functional connectivity at rest and during stress compared to healthy controls?
Case-Control (n=16)
No
Does a previous episode of Takotsubo syndrome alter brain functional connectivity at rest and during stress compared to healthy controls?
p-value: p=0.041
Patients with a history of Takotsubo syndrome exhibit altered brain functional connectivity in autonomic and emotional regulation networks both at rest and during stress, supporting a central neurogenic mechanism for the syndrome.
Altered brain connectivity in prior TTS patients should not yet inform management; leaves open central ANS reorganization as a hypothesis for pathogenesis.
Takotsubo syndrome (TTS) is an acute, reversible cardiomyopathy. The central autonomic nervous system (ANS) is believed to play a role in this disease. The aim of the present study was to investigate the patterns of brain functional connectivity in a sample of patients who had experienced a previous episode of TTS. Brain functional connectivity, both at rest and in response to the stressful stimulus of topical cold stimulation, was explored using functional magnetic resonance imaging (fMRI), network-based statistics (NBS) and graph theory analysis (GTA) in a population consisting of eight patients with a previous episode of TTS and eight sex- and age-matched controls. At rest, a network characterized by increased connectivity in the TTS group compared to controls and comprising elements of the central ANS was identified. GTA revealed increased local efficiency, clustering and strength in regions of the bilateral hippocampus in subjects with a previous episode of TTS. When stressed by local exposure to cold, the TTS group differed significantly from both a pre-stress baseline interval and from the control group, showing increased connectivity in a network that included the left amygdala and the right insula. Based on the results, patients with TTS display a reorganization of cortical and subcortical networks, including areas associated with the emotional response and autonomic regulation. The findings tend to support the hypothesis that a deregulation of autonomic control at the central level plays a significant role in this syndrome.
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Silva et al. (2019) conducted a case-control in Takotsubo Syndrome (n=16). Previous episode of Takotsubo Syndrome vs. Healthy age- and sex-matched controls was evaluated on Brain functional connectivity at rest (network-based statistics) (p=0.041). Patients with a previous episode of Takotsubo syndrome displayed increased functional connectivity in central autonomic nervous system networks both at rest and during a cold stressor challenge.
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