title: The Insular Cortex and Takotsubo Cardiomyopathy.
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 the concept 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 the central autonomic nervous system in relation to emotional stress such as anxiety, fear and sadness. Because the Ic is located in the region of the middle cerebral arteries, its structure tends to be exposed to a higher risk of cerebrovascular disease. Ic damage has been associated with myocardial injury, increased brain natriuretic peptide, and the 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. In this review, we focus on the role of the Ic as a mediator for the cardiovascular system in relation to emotional stress, and we summarizes the current knowledge on the relationships between the Ic and Takotsubo cardiomyopathy.
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, 2-1-1, Kabeminami, Aaskita-ku, Hiroshima 731-0293, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Nagai
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Dote
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Shota
authors.initials: S
authors.lastname: Sasaki
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Oda
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Kagawa
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Nakano
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Yamane
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Tasuku
authors.initials: T
authors.lastname: Higashihara
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima. Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Miyauchi
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima. Japan.
authors.forename: Akane
authors.initials: A
authors.lastname: Tsuchiya
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima. Japan.
authors.forename: Wakako
authors.initials: W
authors.lastname: Harada
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi. Japan.
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
mesh_terms: D002540:Cerebral Cortex / Q000378:metabolism* / Q000503:physiopathology; D006801:Humans; D054549:Takotsubo Cardiomyopathy / Q000378:metabolism* / Q000503:physiopathology
keywords: Insular cortex; stroke; sympathetic nervous system; takotsubo cardiomyopathy