The Insular Cortex and Takotsubo Cardiomyopathy

Abstract

Transient left ventricular dysfunction in patients under emotional stress, also known as Takotsubo cardiomyopathy, has been recognized as a distinct clinical entity. Recent studies have supported the concept notion that the cardiovascular system is regulated by cortical modulation. A network consisting of the insular cortex (Ic), anterior cingulate gyrus, and amygdala plays a crucial role in the regulation of the central autonomic nervous system in relation to emotional stress such as anxiety, fear and sadness. Because the Ic is located in the region of the middle cerebral arteries, its structure tends to be exposed to a higher risk of cerebrovascular disease. Ic damage has been associated with myocardial injury, increased brain natriuretic peptide, and the incidence of Takotsubo cardiomyopathy. Because Ic damage has been associated with increased sympathetic nervous system activity, Ic damage is suggested to have a pivotal role in the pathophysiology of Takotsubo cardiomyopathy. In this review, we focus on the role of the Ic as a mediator for the cardiovascular system in relation to emotional stress, and we summarizes the current knowledge on the relationships between the Ic and Takotsubo cardiomyopathy.

Atrial fibrillation after acute intracerebral hemorrhage: how would the insular cortex damage interact?

“…In addition, recent studies have supported the notion that the cardiovascular system is regulated by a central autonomic network consisting of Ic, anterior cingulate gyrus and amygdala [3]. Oppenheimer et al [4] identified a site of cardiac representation within the Ic.…”

Insular cortex and QT correction interval: an effect of hemispheric lateralization?

“…In a dog model, the adjusted QT interval at high parasympathetic or low sympathetic tone was significantly longer than that at low parasympathetic or high sympathetic tone [2]. However, recent studies have supported the notion that the cardiovascular system is regulated by a cortical network consisting of the Ic, anterior cingulate gyrus and amygdala [3]. Several points should be taken into account when interpreting these results reported by Turri et al [1].…”

Sex hormones in heart failure revisited?

“…In the early 1990s, reversible cardiomyopathy precipitated by acute emotional stress was reported . The patients were usually post‐menopausal women and often developed signs and symptoms of acute coronary syndrome proximate to a strong emotional stressor associated with a transient apical and mid‐ventricular wall motion abnormality despite the absence of obstructive coronary artery disease at the time of emergent coronary angiography . This syndrome was originally termed as Takotsubo cardiomyopathy .…”

“…14,15 This syndrome was originally termed as Takotsubo cardiomyopathy. 15 Although the clinical manifestations of Takotsubo cardiomyopathy and those in HFrEF with DM are different, the status of post-menopausal women seems to be a common risk, and reduced oestradiol level might serve as a common underlying pathophysiology. The complexity for the relationship between sex steroid hormone and cardiovascular system gives us a glimpse to understand the precise pathophysiology in those disorders.…”