Functional connectivity in the limbic system of the brain, which controls emotion and the autonomic system, is reduced in patients with Takotsubo syndrome compared with healthy individuals. This finding comes from a study using resting-state functional MRI, now published in European Heart Journal.

Investigators recruited 15 women with Takotsubo syndrome (only ~10% of cases of Takotsubo syndrome occur in men) and 39 age-matched, female control individuals and assessed resting state functional connectivity in the brain — that is, the extent to which two brain regions are simultaneously activated, which indicates that they are communicating. Four different sets of brain network nodes were assessed: sympathetic, parasympathetic, default mode and whole brain.

Resting-state functional connectivity was reduced in the sympathetic, parasympathetic and default networks in patients with Takotsubo syndrome compared with healthy control individuals. In addition, the assessment of the whole-brain network identified hypoconnectivity in the limbic system, which includes areas such as the amygdala, cingulate gyrus, hippocampus and insula that are involved in emotional processing and control of the autonomic nervous system and cardiac function. In addition, the cingulate gyrus is an important structure in depression, which is common in patients with Takotsubo syndrome. Of note, the investigators had previously identified structural alterations in patients with Takotsubo syndrome in the same regions of the brain in which functional hypoconnectivity was identified in this study.

“While there are likely [to be] many causes of Takotsubo syndrome … the present findings suggest that alterations in the function of certain parts of the central nervous system may result in the onset of a Takotsubo syndrome event in response to a stressful trigger,” conclude the researchers.