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. (J Am Coll Cardiol HF 2023;11:307-317) © 2023 The Authors. Published by Elsevier on behalf of
the American College of Cardiology Foundation. This is an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/).
ISSN 2213-1779 https://doi.org/10.1016/j.jchf.2022.11.001
From
Year
2022
Category
Refereed journal