The role of central autonomic nervous system dysfunction in Takotsubo syndrome: a systematic review

Brázdil, Vojtěch; Kala, Petr; Hudec, Martin; Poloczek, Martin; Kaňovský, Jan; Štípal, Roman; Jeřábek, Petr; Boček, Otakar; Pail, Martin; Brázdil, Milan

doi:10.1007/s10286-021-00844-z

Cited by 8 publications

(5 citation statements)

References 39 publications

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“…Cardiac dysautonomia can present itself as paroxysmal sympathetic hyperactivity 30 potentially involving arrhythmias and impaired myocardial contractility, as it is the case in stress‐induced cardiomyopathies 31,32 or result on the contrary in bradycardia and hypotension with diminished vasomotor tone. It is better described by measures of HRV and seems to be a key feature of many critical conditions, as it has been reported in various etiologies of brain injury such as brain death, 33 stroke, 11 subarachnoid hemorrhage, 34 or TBI 9 as well as in non‐brain‐injured critically ill patients 12 .…”

Section: Discussionmentioning

confidence: 99%

Aberrant brain–heart coupling is associated with the severity of post cardiac arrest brain injury

Hermann,

Candia‐Rivera,

Sharshar

et al. 2024

Ann Clin Transl Neurol

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ObjectiveTo investigate autonomic nervous system activity measured by brain–heart interactions in comatose patients after cardiac arrest in relation to the severity and prognosis of hypoxic–ischemic brain injury.MethodsStrength and complexity of bidirectional interactions between EEG frequency bands (delta, theta, and alpha) and ECG heart rate variability frequency bands (low frequency, LF and high frequency, HF) were computed using a synthetic data generation model. Primary outcome was the severity of brain injury, assessed by (i) standardized qualitative EEG classification, (ii) somatosensory evoked potentials (N20), and (iii) neuron‐specific enolase levels. Secondary outcome was the 3‐month neurological status, assessed by the Cerebral Performance Category score [good (1–2) vs. poor outcome (3–4–5)].ResultsBetween January 2007 and July 2021, 181 patients were admitted to ICU for a resuscitated cardiac arrest. Poor neurological outcome was observed in 134 patients (74%). Qualitative EEG patterns suggesting high severity were associated with decreased LF/HF. Severity of EEG changes were proportional to higher absolute values of brain‐to‐heart coupling strength (p < 0.02 for all brain‐to‐heart frequencies) and lower values of alpha‐to‐HF complexity (p = 0.049). Brain‐to‐heart coupling strength was significantly higher in patients with bilateral absent N20 and correlated with neuron‐specific enolase levels at Day 3. This aberrant brain‐to‐heart coupling (increased strength and decreased complexity) was also associated with 3‐month poor neurological outcome.InterpretationOur results suggest that autonomic dysfunctions may well represent hypoxic–ischemic brain injury post cardiac arrest pathophysiology. These results open avenues for integrative monitoring of autonomic functioning in critical care patients.

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Section: Discussionmentioning

confidence: 99%

Aberrant brain–heart coupling is associated with the severity of post cardiac arrest brain injury

Hermann,

Candia‐Rivera,

Sharshar

et al. 2024

Ann Clin Transl Neurol

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“…However, beta-blockers might be of beneficial effect in TTS patients who are suffering from primary electrical disease. Recently published review articles presented an in-depth evaluation of interaction between catecholamine excess and β-adrenergic receptor signaling, G-protein coupled receptor kinases, calcium hemostasis, myofilament physiology, cardiomyocyte gene expression, cellular electrophysiology, inflammation, metabolism, central and peripheral nervous system, autonomic nervous system, hormone factors, the recently used microRNA vaccines, and energetics through different underlying pathways [ 24 , 25 , 26 ]. Of note, two categories of TTS have been described, primary TTS cases and secondary TTS cases.…”

Section: Discussionmentioning

confidence: 99%

A Case Series of Concomitant Cardiac Electrical Disease among Takotsubo Syndrome Patients and Literature Review

El‐Battrawy

Erath

Vámos

et al. 2022

JCDD

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The pathophysiology of Takotsubo Syndrome (TTS) is not completely understood and the trigger of sudden cardiac death (SCD) in TTS is not clear either. We therefore sought to find an association between TTS and primary electrical diseases. A total of 148 TTS patients were analyzed between 2003 and 2017 in a bi-centric manner. Additionally, a literature review was performed. The patients were included in an ongoing retrospective cohort database. The coexistence of TTS and primary electrical diseases was confirmed in five cases as the following: catecholaminergic polymorphic ventricular tachycardia (CPVT, 18-year-old female) (n = 1), LQTS 1 (72-year-old female and 65-year-old female) (n = 2), LQTS 2 (17-year-old female) (n = 1), and LQTS in the absence of mutations (22-year-old female). Four patients suffered from malignant tachyarrhythmia and recurrent syncope after TTS. Except for the CPVT patient and one LQTS 1 patient, all other cases underwent subcutaneous ICD implantation. An event recorder of the CPVT patient after starting beta-blocker did not detect arrhythmias. The diagnosis of primary electrical disease was in 80% of cases unmasked on a TTS event. This diagnosis triggered a family clinical and genetic screening confirming the diagnosis of primary electrical disease. A subsequent literature review identified five cases as the following: a congenital atrioventricular block (n = 1), a Jervell and Lange-Nielsen Syndrome (n = 1), and a family LQTS in the absence of a mutation (n = 2), LQTS 2 (n = 1). A primary electrical disease should be suspected in young and old TTS patients with a family history of sudden cardiac death. In suspected cases, e.g., ongoing QT interval prolongation, despite recovery of left ventricular ejection fraction a family screening is recommended.

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“…While around seven percent of TTS events are associated with clear neurologic triggers, such as seizures or intracranial bleeding [ 16 ], there is evolving evidence that the brain–heart axis is genuinely involved in the general pathogenesis of this condition, mainly involving the central autonomic nervous system (for review, see [ 17 , 18 ]). As no current TTS therapies exist, this underexplored field of neuro-cardiology might be of particular interest to develop new management approaches, including cognitive behavioral therapy and/or physical exercise training.…”

Section: Discussionmentioning

confidence: 99%

Limbic Responses to Aversive Visual Stimuli during the Acute and Recovery Phase of Takotsubo Syndrome

Steiger

Tuovinen

Adukauskaitė

et al. 2022

JCM

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The role of the limbic system in the acute phase and during the recovery of takotsubo syndrome needs further clarification. In this longitudinal study, anatomical and task-based functional magnetic resonance imaging of the brain was performed during an emotional picture paradigm in 19 postmenopausal female takotsubo syndrome patients in the acute and recovery phases in comparison to sex- and aged-matched 15 healthy controls and 15 patients presenting with myocardial infarction. Statistical analyses were performed based on the general linear model where aversive and positive picture conditions were included in order to reveal group differences during encoding of aversive versus positive pictures and longitudinal changes. In the acute phase, takotsubo syndrome patients showed a lower response in regions involved in affective and cognitive emotional processes (e.g., insula, thalamus, frontal cortex, inferior frontal gyrus) while viewing aversive versus positive pictures compared to healthy controls and patients presenting with myocardial infarction. In the recovery phase, the response in these brain regions normalized in takotsubo syndrome patients to the level of healthy controls, whereas patients 8–12 weeks after myocardial infarction showed lower responses in the limbic regions (mainly in the insula, frontal regions, thalamus, and inferior frontal gyrus) compared to healthy controls and takotsubo syndrome patients. In conclusion, compared to healthy controls and patients suffering from acute myocardial infarction, limbic responses to aversive visual stimuli are attenuated during the acute phase of takotsubo syndrome, recovering within three months. Reduced functional brain responses in the recovery phase after a myocardial infarction need further investigation.

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The role of central autonomic nervous system dysfunction in Takotsubo syndrome: a systematic review

Cited by 8 publications

References 39 publications

Aberrant brain–heart coupling is associated with the severity of post cardiac arrest brain injury

Aberrant brain–heart coupling is associated with the severity of post cardiac arrest brain injury

A Case Series of Concomitant Cardiac Electrical Disease among Takotsubo Syndrome Patients and Literature Review

Limbic Responses to Aversive Visual Stimuli during the Acute and Recovery Phase of Takotsubo Syndrome

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