Michiaki Nagai
Hiroshima City Asa Hospital, Hiroshima, Japan
Title: The insular cortex and Takotsubo cardiomyopathy
Biography
Biography: Michiaki Nagai
Abstract
Transient left ventricular dysfunction in patients under emotional stress, also known as takotsubo cardiomyopathy, has been recognized as a distinct clinical entity. Recent studies have supported a notion that the cardiovascular system is regulated by cortical modulation. A network consisting of the insular cortex (Ic), anterior cingulate gyrus, and amygdala plays a crucial role in the regulation of central autonomic nervous system in relation to emotional stress such as anxiety, fear and sadness. Because, Ic is located in the region of the middle cerebral arteries, its structure tends to be exposed to a higher risk of cerebrovascular disease. And Ic damage has been associated with myocardial injury, increased brain natriuretic peptide and incidence of takotsubo cardiomyopathy. Because, Ic damage has been associated with increased sympathetic nervous system activity, Ic damage is suggested to have a pivotal role in the pathophysiology of takotsubo cardiomyopathy. We focus on the role of Ic as a mediator for the cardiovascular system in relation to emotional stress, and summarizes current knowledge on the relationships between Ic and takotsubo cardiomyopathy.
