Article Text
Abstract
Introduction and objective Dysfunctional central autonomic nervous system network (CAN) at rest may result in aberrant autonomic responses to psychosocial stressors. We hypothesised that patients with primary microvascular angina (MVA) or Takotsubo syndrome (TTS) would exhibit a peculiar functional organisation of the CAN, potentially associated with psychological patterns.
Methods Patients underwent a psychosocial evaluation: a clinical diagnostic interview, Millon Clinical Multiaxial Inventory III, State-Trait Anxiety Inventory form Y and Short Form 36 Health Survey (SF-36). The strength of intrinsic functional connectivity (FC) between various nodes of the CAN was investigated using cerebral resting state functional MRI (RS-fMRI).
Results We evaluated 50 (46 women) stable patients: 16 patients with MVA, 17 patients with TTS and 17 patients with previous acute myocardial infarction (AMI). Compared with AMI, patients with MVA showed a lower (higher impairment) SF-36 Body-Pain score (p 0.046) and a higher SF-36 Mental-Health score (p 0.039). Patients with TTS showed the strongest FC between two nodes of the CAN (sympathetic midcingulate cortex and parasympathetic primary motor area) (F 6.25, p 0.005) using RS-fMRI.
Conclusions The study implements an innovative collaborative research among cardiologists, neuroscientists and psychiatrists (‘Neuro-psycho-heart Team’). MVA showed a discrepancy between the highest level of self-reported body pain and the best mental health score, which might suggest a mechanism of somatisation. TTS exhibited an increased functional integration between two areas of the CAN involved in interoceptive pain awareness and negative emotional status. We implemented an innovative research collaboration among cardiologists, neuroscientists and psychiatrists. These data are hypothesis generating and suggest potential prospective investigations on pathophysiology and implementation of psychotherapy and stress-reducing techniques as therapeutic strategies.
Trial registration number NCT02759341.
- autonomic regulation
- endothelial function
- cardiomyopathy apical
- microvascular
- syndrome X
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Footnotes
MMC and EP contributed equally.
AG and MC contributed equally.
Contributors MMC, MC and AG contributed to the conception, planning, conduct, reporting, manuscript conception, drafting and final approval and are responsible for the overall content as guarantors. EP, MP and CC contributed to the planning, conduct, manuscript drafting and final approval. CL contributed to the statistical analysis, manuscript drafting and final approval. MM, AK, IS, LB, CG and FC contributed to the manuscript conception, drafting and final approval.Patients appreciated and supported an innovative collaboration between cardiologists, neuroscientists and psychiatrists working as a 'Neuro-psycho-heart Team', investigating their disorders. In this way, patients were involved in development of the research questions and aims. They were not involved in the other stages of the study.
Funding This study was funded by Swiss Heart Foundation.
Competing interests AG reports grants from the Swiss Heart Foundation and the ABREOC for unrelated work; IS reports grants from Swiss Heart Foundation and Swiss National Foundation for unrelated work.
Patient consent for publication Not required.
Ethics approval The study was conducted according to the principles of the Declaration of Helsinki, approved by the local ethics review board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available.