Khan Hilal, Gamble David T, Rudd Amelia, Mezincescu Alice M, Abbas Hassan, Noman Awsan, Stewart Andrew, Horgan Graham, Krishnadas Rajeev, Williams Christopher, Waiter Gordon D, Dawson Dana K
University of Aberdeen, Aberdeen, United Kingdom.
University of Aberdeen, Aberdeen, United Kingdom.
JACC Heart Fail. 2023 Mar;11(3):307-317. doi: 10.1016/j.jchf.2022.11.001. Epub 2023 Jan 11.
Takotsubo syndrome mimics an acute myocardial infarction, typically in the aftermath of mental or physical stress.
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.
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.
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).
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.
应激性心肌病通常在精神或身体应激后出现，酷似急性心肌梗死。
应激状态下情绪加工导致严重心脏损伤的机制尚不清楚，因此对应激性心肌病患者的脑结构和功能进行全面探索值得研究。
本观察性横断面研究招募了25例急性（<5天）应激性心肌病患者和25名对照者。对磁共振成像（MRI）脑部扫描进行基于表面的形态测量，使用Freesurfer软件基于体积、厚度和表面积提取皮质形态。皮质形态通用线性模型针对年龄、性别、光周期和全脑体积进行了校正。使用脑扩散工具箱和功能连接工具箱对静息态功能MRI和扩散张量纤维束成像图像进行预处理和分析。
应激性心肌病患者的总白质和皮质下灰质体积显著较小（P<0.001），全脑表面积较小，但总皮质厚度增加（均P<0.001）。应激性心肌病患者的单个灰质区域（海马体等）显著较小（P<0.001）；只有丘脑和岛叶较大（P<0.001）。包括丘脑-杏仁核-岛叶和基底神经节在内的多个区域存在显著的功能亢进和功能减退连接（P<0.05）。应激性心肌病患者所有的结构纤维束连接均增加（P<0.05）。
作者发现，由于皮质表面积较小，灰质和白质体积减小，但皮质厚度增加，且结构纤维束连接增加，同时与情绪、语言、推理、感知和自主控制相关的功能连接出现双向变化。这些是应激性心肌病患者康复的干预靶点。
