Structural and Functional Brain Features in Takotsubo Syndrome

Takotsubo syndrome is featured by transient left ventricular dysfunction typically triggered by emotional or physical stress. Growing evidence supports a pivotal role of brain-heart interactions in its pathophysiology. Structural neuroimaging studies have identified reduced cortical thickness and gray matter volume in limbic and autonomic regulatory regions, including the insula, cingulate cortex, and amygdala. Functional imaging studies, including 18F-fluorodeoxyglucose (FDG) PET and functional MRI, have demonstrated persistent amygdalar hyperactivity, altered limbic system activity, and widespread hypoconnectivity within autonomic and emotional regulation networks. Importantly, several of these abnormalities appear to persist long after recovery of cardiac function.