Abstract Details

Title Takotsubo Cardiomyopathy: A Brain Network that Breaks Your Heart

Topic General Neurology

Presentation(s) S43 - General Neurology 2 (1:12 PM-1:24 PM)

Poster/Presentation
Number 002

Background Takotsubo cardiomyopathy - also known as broken-heart syndrome - is a type of acute heart failure that can lead to sudden death. It is commonly triggered by intense emotional or physical distress such as a divorce, earthquakes, or a surprise party; leading to a surge of the sympathetic nervous system. However, takotsubo cardiomyopathy can also be caused by brain lesions, potentially lending insight into the brain regions and networks involved in nervous system control of the heart.

Objective To test whether lesions causing takotsubo cardiomyopathy map to a common brain network.

Design/Methods We performed a systematic literature search and collected all published cases of brain lesions causing takotsubo cardiomyopathy. Lesions were mapped to a common brain template and the brain network functionally connected to each lesion location was computed using resting state functional MRI data of 1000 healthy participants (human connectome), a method termed ‘lesion network mapping’.Functional connections specific to lesions causing takotsubo cardiomyopathy were identified using control lesions causing other non-specific symptoms (n = 490) and a whole-brain voxel-wise t-test with 10,000 permutations, controlling for lesion volume as a covariate.

Results We identified 61 publications describing 72 cases of lesion-induced takotsubo cardiomyopathy (50 [69%] females, mean [SD] age, 52.9 [24.9] years). Lesions causing takotsubo cardiomyopathy occurred in multiple heterogeneous locations spanning different cortical lobes and subcortex of left (n=19), right (n=25) or both hemispheres (n=28). However, these same lesion locations were part of a specific brain network functionally connected to the vagal nucleus in the medulla (p<0.01). Repeating this analysis excluding lesions directly involving the medulla gave a similar result (p<0.05), suggesting a diaschisis-like network effect.

Conclusions The findings in this study indicate that lesions causing takotsubo cardiomyopathy map to a brain network defined by functional connectivity to the vagal nucleus, a brain region previously implicated in parasympathetic nervous system control of the heart.

Authors/Disclosures
Frederic Schaper, MD, PhD (Brigham and Women's) PRESENTER	Dr. Schaper has nothing to disclose.
Kyuree Kim	No disclosure on file
Mae Morton-Dutton	No disclosure on file
Ona Wu (MGH Stroke Research Center)	No disclosure on file
Natalia S. Rost, MD, MPH, FAHA, FAAN (Massachusetts General Hospital)	Dr. Rost has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for American Academy of Neurology. Dr. Rost has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care.
Michael D. Fox, MD, PhD (Brigham and Women's Hospital / Harvard Medical School)	Dr. Fox has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley.