Abstract
Takotsubo syndrome (TTS), a transient form of dysfunction in the heart’s left ventricle, occurs predominantly in postmenopausal women who have emotional stress. Earlier studies support the concept that the human circulatory system is modulated by a cortical network (consisting of the anterior cingulate gyrus, amygdala, and insular cortex (Ic)) that plays a pivotal role in the central autonomic nervous system in relation to emotional stressors. The Ic plays a crucial role in the sympathovagal balance, and decreased levels of female sex hormones have been speculated to change functional cerebral asymmetry, with a possible link to autonomic instability. In this review, we focus on the Ic as an important moderator of the human brain–heart axis in association with sex hormones. We also summarize the current knowledge regarding the sex-specific neuroanatomy in TTS.
Highlights
Syndrome: Is the Insular Cortex a Takotsubo syndrome (TTS)—a transient form of left ventricular (LV) dysfunction in individuals who are under emotional stress—has been known as an acute syndrome with akinesis from the heart’s mid-left ventricle to the apex [1]
It has been speculated that a cortical network comprised of the anterior cingulate cortex (ACC), amygdala, and insular cortex (Ic) regulates the human cardiovascular system, and that the network of these cortical regions is necessary to regulate the central autonomic network (CAN) in response to emotional stress [3]
In their analysis of heart rate variability (HRV), Yoon et al [22] observed that the low frequency (LF) per high frequency (HF) ratio, which represents the activity of the sympathetic nervous system, significantly changed with the left hemisphere inactivation
Summary
Syndrome: Is the Insular Cortex a Takotsubo syndrome (TTS)—a transient form of left ventricular (LV) dysfunction in individuals who are under emotional stress—has been known as an acute syndrome with akinesis from the heart’s mid-left ventricle to the apex [1]. Several pathophysiologic conditions are thought to be linked in the brain–heart regulatory axis and are associated with left ventricular (LV) dysfunction. The present review describes the sex-specific neuroanatomy in TTS and updates the knowledge regarding the integrated roles of the Ic in the brain–heart axis. We discuss these topics mainly from a pathophysiological standpoint, focusing on the relationships between the Ic and sex hormones and TTS. Biomolecules 2022, 12, 110 regarding the relationship between Ic damage and TTS, which is speculated to be moderregarding the relationship between Ic damage and TTS, which is speculated to be moderated ated by estrogen deficiency
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