Functional neuroimaging in the acute phase of Takotsubo syndrome: volumetric and functional changes of the right insular
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ORIGINAL PAPER
Functional neuroimaging in the acute phase of Takotsubo syndrome: volumetric and functional changes of the right insular cortex Wolfgang Dichtl1 · Noora Tuovinen1 · Fabian Barbieri1 · Agne Adukauskaite1 · Thomas Senoner1 · Andrea Rubatscher1 · Florian Hintringer1 · Christian Siedentopf2 · Axel Bauer1 · Elke R. Gizewski2,3 · Ruth Steiger2,3 Received: 24 August 2019 / Accepted: 15 January 2020 © The Author(s) 2020
Abstract Background A brain–heart interaction has been proposed in Takotsubo syndrome (TTS). Structural changes in the limbic system and hypoconnectivity between certain brain areas in the chronic phase of the disease have been reported, but little is known concerning functional neuroimaging in the acute phase. We hypothesizedh anatomical and functional changes in the central nervous system and investigated whole-brain volumetric and functional connectivity alterations in the acute phase TTS patients compared to controls. Methods Anatomical and resting-state functional magnetic resonance imaging were performed in postmenopausal females: thirteen in the acute TTS phase and thirteen healthy controls without evidence of coronary artery disease. Voxel-based morphometry and graph theoretical analysis were applied to identify anatomical and functional differences between patients and controls. Results Significantly lower gray matter volumes were found in TTS patients in the right middle frontal gyrus (p = 0.004) and right subcallosal cortex (p = 0.009) compared to healthy controls. When lower threshold was applied, volumetric changes were noted in the right insular cortex (p = 0.0113), the right paracingulate cortex (p = 0.012), left amygdala (p = 0.018), left central opercular cortex (p = 0.017), right (p = 0.013) and left thalamus (p = 0.017), and left cerebral cortex (p = 0.017). Graph analysis revealed significantly (p
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