Structural and functional brain changes in acute takotsubo syndrome

Khan, H. et al. (2023) Structural and functional brain changes in acute takotsubo syndrome. JACC: Heart Failure, 11(3), pp. 307-317. (doi: 10.1016/j.jchf.2022.11.001) (PMID:36752489)

Abstract

Background: Takotsubo syndrome mimics an acute myocardial infarction, typically in the aftermath of mental or physical stress. Objectives: The mechanism by which emotional processing in the context of stress leads to significant cardiac injury is poorly understood, so a full exploration of brain structure and function in takotsubo syndrome patients merits investigation. Methods: Twenty-five acute (<5 days) takotsubo patients and 25 control subjects were recruited into this observational cross-sectional study. Surface-based morphometry was carried out on magnetic resonance imaging (MRI) brain scans to extract cortical morphology based on volume, thickness, and surface area with the use of Freesurfer. Cortical morphology general linear models were corrected for age, sex, photoperiod, and total brain volume. Resting-state functional MRI and diffusion tensor tractography images were preprocessed and analyzed with the use of the Functional Magnetic Resonance Imaging of the Brain Diffusion Toolbox and Functional Connectivity Toolbox. Results: There was significantly smaller total white matter and subcortical gray matter volumes in takotsubo (P < 0.001), with smaller total brain surface area but increased total cortical thickness (both P < 0.001). Individual gray matter regions (hippocampus and others) were significantly smaller in takotsubo (P < 0.001); only thalamus and insula were larger (P < 0.001). There was significant hyperfunctional and hypofunctional connectivity in multiple areas, including thalamus-amygdala-insula and basal ganglia (P < 0.05). All structural tractography connections were increased in takotsubo (P < 0.05). Conclusions: The authors showed smaller gray and white matter volumes driven by smaller cortical surface area, but increased cortical thickness and structural tractography connections with bidirectional changes in functional connectivity linked to emotion, language, reasoning, perception, and autonomic control. These are interventional targets in takotsubo patients’ rehabilitation.

• Item Type: Articles
• Additional Information: This work was supported by National Health Service Grampian Endowment EA9667/ES868.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Williams, Professor Christopher and Krishnadas, Dr Rajeev
• Authors: Khan, H., Gamble, D. T., Rudd, A., Mezincescu, A. M., Abbas, H., Noman, A., Stewart, A., Horgan, G., Krishnadas, R., Williams, C., Waiter, G. D., and Dawson, D. K.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
• Journal Name: JACC: Heart Failure
• Publisher: Elsevier
• ISSN: 2213-1779
• ISSN (Online): 2213-1787
• Published Online: 11 January 2023
• Copyright Holders: Copyright © 2022 Elsevier on behalf of the American College of Cardiology Foundation
• First Published: First published in JACC: Heart Failure 11(3): 307-317
• Publisher Policy: Reproduced under a Creative Commons License