Author(s):
Pereira, Vitor H. ; Marques, Paulo César Gonçalves ; Magalhães, Ricardo José Silva ; Português, João ; Calvo, Lucy ; Cerqueira, João José ; Sousa, Nuno
Date: 2016
Persistent ID: http://hdl.handle.net/1822/44903
Origin: RepositóriUM - Universidade do Minho
Project/scholarship:
info:eu-repo/grantAgreement/EC/FP7/259772/EU;
info:eu-repo/grantAgreement/FCT/3599-PPCDT/127675/PT
;
info:eu-repo/grantAgreement/FCT/3599-PPCDT/127675/PT
;
Subject(s): Central autonomic nervous system; Sympathetic nervous system; Insular cortex; Takotsubo cardiomyopathy; Functional magnetic resonance imaging; Stress; Science & Technology
Description
Aims: Takotsubo cardiomyopathy is an intriguing disease characterized by acute transient left ventricular dysfunction usually triggered by an episode of severe stress. The excessive levels of catecholamines and the overactivation of the sympathetic system are believed to be the main pathophysiologic mechanisms of Takotsubo cardiomyopathy, but it is unclear whether there is a structural or functional signature of the disease. In this sense, our aim was to characterize the central autonomic system response to autonomic challenges in patients with a previous episode of Takotsubo cardiomyopathy when compared with a control group of healthy volunteers. Methods and results: Functional magnetic resonance imaging (fMRI) was performed in four patients with a previous episode of Takotsubo cardiomyopathy (average age of 6712 years) and in eight healthy volunteers (average age of 66 +/- 5 years) while being submitted to different autonomic challenges (cold exposure and Valsalva manoeuvre). The fMRI analysis revealed a significant variation of the blood oxygen level dependent signal triggered by the Valsalva manoeuvre in specific areas of the brain involved in the cortical control of the autonomic system and significant differences in the pattern of activation of the insular cortex, amygdala and the right hippocampus between patients with Takotsubo cardiomyopathy and controls, even though these regions did not present significant volumetric changes. Conclusion: The central autonomic response to autonomic challenges is altered in patients with Takotsubo cardiomyopathy, thus suggesting a dysregulation of the central autonomic nervous system network. Subsequent studies are needed to unveil whether these alterations are causal or predisposing factors to Takotsubo cardiomyopathy.
The work was supported by the European Commission (FP7): ‘SwitchBox’ (Contract HEALTH-F2-2010-259772) and ‘MyHealth’ project (Contract DoIT-13853), and by Fundação para a Ciência e Tecnologia (project FCT-ANR/NEU-OSD/0258/2012 Portuguese North Regional Operational Program (ON.2 – O Novo Norte)) under the National Strategic Reference Framework (QREN), through the European Regional Development Fund (FEDER). PM is supported by a ‘SwitchBox’ fellowship and RM by a FCT-ANR/NEU-OSD/0258/2012 fellowship.
