Autonomic and cardiovascular consequences resulting from experimental hemorrhagic stroke in the left or right intermediate insular cortex in rats

Marins, Fernanda Ribeiro; Limborço-Filho, Marcelo; D'Abreu, Bárbara Flecha; Almeida, Paulo Henrique Ribeiro Fernandes; Gavioli, Mariana; Xavier, Carlos Henrique; Oppenheimer, Stephen; Guatimosim, Sílvia; Fontes, Marco Antônio Peliky

doi:10.1016/j.autneu.2020.102695

“…Insula is important to cardiac sympathetic output maintenance. ICH patients whose insula was involved had an increased risk of cardiac complications [23], which is consistent with our findings. It also showed that the risk was elevated when the right hemisphere was involved.…”

Section: Discussionsupporting

confidence: 92%

Changes of Electrocardiogram and Myocardial Enzymes in Patients with Intracerebral Hemorrhage

Qin

¹

,

Dai

²

,

Shuang

³

et al. 2022

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Purpose. Cardiac complications are common in patients with spontaneous intracerebral hemorrhage (ICH). The present study is aimed at observing the incidence of cardiac complications after ICH, so as at improving the understanding of the relationship between cardiac complications and ICH. Methods. This is a retrospective study on analyzing electrocardiogram (ECG) and serum myocardial enzyme of 208 patients with ICH admitted to a tertiary hospital from 2018 to 2019. For each patient, demographics, medical history, clinical presentation, ECG, serum myocardial enzyme, and head CT on admission were reviewed. Mortality was noted. Results. Among the 208 patients, 145 (69.71%) had one or more ECG abnormalities. The top three abnormalities were corrected QT interval (QTc) prolongation 52 (25%), ST depression 48 (23.08%), and T wave inversion 38 (18.27%). One hundred and thirty-nine patients (66.83%) had increased serum levels of at least one kind of myocardial enzyme, which were high-sensitive cardiac troponin T (hs-cTnT) 79 (37.98%), lactic dehydrogenase (LDH) 80 (38.46%), creatine kinase (CK) 57 (27.40%), and creatine kinase-myocardial subfraction (CKMB) 57 (27.40%). The logistic regression analysis showed the following: secondary intraventricular hemorrhage (SIVH) (odds ratio (OR) 5.32; 95% confidence interval (CI) 2.55–11.08; p < 0.001 ) and hematoma volume > 30 ml (OR 3.81; 95% CI 1.86–7.81; p < 0.001 ) were independent predictive factors of QTc prolongation; thalamus location (OR 5.79; 95% CI 1.94–17.28; p < 0.05 ), hematoma volume > 30 ml (OR 24.187; 95% CI 3.14-186.33; p < 0.05 ), insular involvement (OR 19.08; 95% CI 5.77-63.07; p < 0.001 ), and SIVH (OR 2.62; 95% CI 1.69-5.86; p < 0.05 ) were independent predictive factors of ST depression; insular involvement (OR 2.90; 95% CI 1.12–7.50; p < 0.05 ) and hematoma volume > 30 ml (OR 1.98; 95% CI 1.06–3.70; p < 0.05 ) were independent predictive factors of increase of CK; Glasgow Coma Scale (GCS) (OR 0.86; 95% CI 0.78–0.98; p < 0.05 ) and insular involvement (OR 5.56; 95% CI 1.98–15.62; p < 0.05 ) were independent predictive factors of increase of CKMB; SIVH (OR 2.05; 95% CI 1.07–3.92; p < 0.05 ) was independent predictive factor of increase of LDH; age (OR 1.03; 95% CI 1.01–1.06; p < 0.05 ), blood glucose on admission (OR 1.10; 95% CI 1.01–1.20; p < 0.05 ), and history of antiplatelet drug use (OR 3.50; 95% CI 1.01–12.12; p < 0.05 ) were independent predictive factors of hs-cTnT. All the injury indexes were not related to in-hospital mortality. Conclusion. The study suggests that insular involvement, hematoma volume > 30 ml, and SIVH are the strongest risk factors for ECG abnormalities and elevated myocardial enzymes after ICH followed which are the risk factors such as GCS, age, admission blood glucose, and ICH location in the thalamus.

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“…Efferents from bradycardic insular cortex have similar projection targets; although, connectivity with the pre-sympathetic regions is less dense. While anterograde tracing indicates that the LH is the primary hypothalamic target of insular cortex, retrograde tracing has identified projections to the DMH and PH (Abrahamson and Moore, 2001;Çavdar et al, 2001;Marins et al, 2020Marins et al, , 2021. In fact, recent reports specify that hemorrhagic stroke in the insula leads to disrupted cardiac sympathetic control and suggest that the DMH may be a downstream mediator (Marins et al, 2020(Marins et al, , 2021.…”

Section: Insular Cortexmentioning

confidence: 99%

Cortical–Hypothalamic Integration of Autonomic and Endocrine Stress Responses

Schaeuble

¹

,

Myers

²

2022

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The prevalence and severity of cardiovascular disease (CVD) are exacerbated by chronic stress exposure. While stress-induced sympathetic activity and elevated glucocorticoid secretion impair cardiovascular health, the mechanisms by which stress-responsive brain regions integrate autonomic and endocrine stress responses remain unclear. This review covers emerging literature on how specific cortical and hypothalamic nuclei regulate cardiovascular and neuroendocrine stress responses. We will also discuss the current understanding of the cellular and circuit mechanisms mediating physiological stress responses. Altogether, the reviewed literature highlights the current state of stress integration research, as well unanswered questions about the brain basis of CVD risk.

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“…The cardiovascular, autonomic, and cardiac changes produced in a focal experimental model of intracerebral hemorrhage (ICH) in the Ic were evaluated by Marins and colleagues [ 20 ]. Although the ICH increased the rats’ baseline HR, cardiac ectopies were markedly increased after 24 h of ICH specifically in the right Ic.…”

Section: The Brain–heart Connectionmentioning

confidence: 99%

“…Although the ICH increased the rats’ baseline HR, cardiac ectopies were markedly increased after 24 h of ICH specifically in the right Ic. Moreover, only in the right Ic ICH cases, the rats hearts’ weight, calcium amplitude, and sarco/endoplasmic reticulum Ca2+-ATPase expression were reduced [ 20 ].…”

Section: The Brain–heart Connectionmentioning

confidence: 99%

Sex Hormone-Specific Neuroanatomy of Takotsubo Syndrome: Is the Insular Cortex a Moderator?

Nagai

¹

,

Förster

²

,

Dote

³

2022

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Takotsubo syndrome (TTS), a transient form of dysfunction in the heart’s left ventricle, occurs predominantly in postmenopausal women who have emotional stress. Earlier studies support the concept that the human circulatory system is modulated by a cortical network (consisting of the anterior cingulate gyrus, amygdala, and insular cortex (Ic)) that plays a pivotal role in the central autonomic nervous system in relation to emotional stressors. The Ic plays a crucial role in the sympathovagal balance, and decreased levels of female sex hormones have been speculated to change functional cerebral asymmetry, with a possible link to autonomic instability. In this review, we focus on the Ic as an important moderator of the human brain–heart axis in association with sex hormones. We also summarize the current knowledge regarding the sex-specific neuroanatomy in TTS.

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Autonomic and cardiovascular consequences resulting from experimental hemorrhagic stroke in the left or right intermediate insular cortex in rats

Cited by 18 publications

References 22 publications

Changes of Electrocardiogram and Myocardial Enzymes in Patients with Intracerebral Hemorrhage

Changes of Electrocardiogram and Myocardial Enzymes in Patients with Intracerebral Hemorrhage

Cortical–Hypothalamic Integration of Autonomic and Endocrine Stress Responses

Sex Hormone-Specific Neuroanatomy of Takotsubo Syndrome: Is the Insular Cortex a Moderator?

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