2006 Heart-Brain summit proceedings

Brain imaging in cardiovascular disease: State of the art

MICHAEL PHILLIPS, MD

The Department of Diagnostic Radiology
Cleveland Clinic
Cleveland, OH

ARTICLE INTRODUCTION

Neuroimaging can be used to directly monitor the heart-brain interaction. Disruptions of the normal heart-brain interaction are common. Abnormalities can originate with cardiac or cardiovascular processes that have neurologic effects, such as embolic stroke and low perfusion states, or with neurologic processes that have direct cardiac effects, such as focal brain lesions caused by stroke or multiple sclerosis (MS).

Brain imaging techniques have advanced to the point where regions involved in changes in autonomic arousal during behavior can be located with precision. These regions can be localized by identifying lost function from specific lesions or by using functional brain imaging, such as positron emission tomography (PET) or magnetic resonance imaging (MRI). This article describes imaging of heart-brain interactions, focusing on functional imaging techniques that have enhanced our understanding of these interactions.

CITATIONS

  1. Rowley HA.
    Extending the time window for thrombolysis: evidence from acute stroke trials. Neuroimaging Clin N Am 2005; 15:575–587.
    http://www.ncbi.nlm.nih.gov/pubmed/16360590

  2. Latchaw RE.
    Cerebral perfusion imaging in acute stroke. J Vasc Interv Radiol 2004; 15:S29–S46.
    http://www.ncbi.nlm.nih.gov/pubmed/15101514
  3. Sunshine JL.
    CT, MR imaging, and MR angiography in the evaluation of patients with acute stroke. J Vasc Interv Radiol 2004; 15:S47–S55.
    http://www.ncbi.nlm.nih.gov/pubmed/15101515
  4. Saver JL.
    Time is brain—quantified. Stroke 2006; 37:263–266.
    http://www.ncbi.nlm.nih.gov/pubmed/16339467
  5. Haensch CA, Jorg J.
    Autonomic dysfunction in multiple sclerosis. J Neurol 2006; 253(Suppl 1):I3–I9.
    http://www.ncbi.nlm.nih.gov/pubmed/16477484
  6. Merkelbach S, Haensch C-A, Hemmer B, Koehler J, König NH, Ziemssen T.
    Multiple sclerosis and the autonomic nervous system. J Neurol 2006; 253(Suppl 1):I21–I25.
    http://www.ncbi.nlm.nih.gov/pubmed/16477481
  7. Kodounis A, Stamboulis E, Constantinidis TS, Liolios A.
    Measurement of autonomic dysregulation in multiple sclerosis. Acta Neurol Scand 2005; 112:403–408.
    http://www.ncbi.nlm.nih.gov/pubmed/16281924
  8. Flachenecker P, Wolf A, Krauser M, Hartung HP, Reiners K.
    Cardiovascular autonomic dysfunction in multiple sclerosis: correlation with orthostatic intolerance. J Neurol 1999; 246:578–586.
    http://www.ncbi.nlm.nih.gov/pubmed/10463360
  9. Lassman AB, Mayer SA.
    Paroxysmal apnea and vasomotor instability following medullary infarction. Arch Neurol 2005; 62:1286–1288.
    http://www.ncbi.nlm.nih.gov/pubmed/16087770
  10. Abboud H, Berroir S, Labreuche J, Orjuele K, Amarenco O.
    Insular involvement in brain infarction increases risk for cardiac arrhythmia and death. Ann Neurol 2006; 59:691–699.
    http://www.ncbi.nlm.nih.gov/pubmed/16566012
  11. Tokgozoglu SL, Batur MK, Topcuoglu MA, Saribas O, Kes S, Oto A.
    Effects of stroke localization on cardiac autonomic balance and sudden death. Stroke 1999; 30:1301–1311.
    http://www.ncbi.nlm.nih.gov/pubmed/10390300
  12. Strittmatter M, Meyer S, Fischer C, Georg T, Schmitz B.
    Location-dependent patterns in cardio-autonomic dysfunction in ischaemic stroke. Eur Neurol 2003; 50:30–38.
    http://www.ncbi.nlm.nih.gov/pubmed/12824710
  13. Laowattana S, Zegler SL, Lima JA, Goodman SN, Wittstein IS, Oppenheimer SM.
    Left insular stroke is associated with adverse cardiac outcome. Neurology 2006; 66:477–483.
    http://www.ncbi.nlm.nih.gov/pubmed/16505298
  14. Kihara M, Nishikawa S, Nakasaka Y, Tanaka H, Takahashi M.
    Autonomic consequences of brainstem infarction. Auton Neurosci 2001; 86:202–207.
    http://www.ncbi.nlm.nih.gov/pubmed/11270098
  15. Korpelainen JT, Huikuri HV, Sotaniemi KA, Myllyla VV.
    Abnormal heart rate variability reflecting autonomic dysfunction in brainstem infarction. Acta Neurol Scand 1996; 94:337–342.
    http://www.ncbi.nlm.nih.gov/pubmed/8947286
  16. Monge Argiles JA, Palacios Ortega F, Vila Sobrino JA, et al.
    Brainstem lesions decrease heart rate variability. Neurologia 2000; 15:158–163.
    http://www.ncbi.nlm.nih.gov/pubmed/10846883
  17. Critchley HD.
    Neural mechanisms of autonomic, affective, and cognitive integration. J Comp Neurol 2005; 493:154–166.
    http://www.ncbi.nlm.nih.gov/pubmed/16254997
  18. Bandettini PA, Wong EC, Hinks RS, Tikofsky RS, Hyde JS.
    Time course EPI of human brain function during task activation. Magn Reson Med 1992; 25:390–397.
    http://www.ncbi.nlm.nih.gov/pubmed/1614324
  19. Kwong KK, Belliveau JW, Chesler DA, et al.
    Dynamic magnetic resonance imaging of human brain activity during primary sensory stimulation. Proc Natl Acad Sci U S A 1992; 89:5675–5679.
    http://www.ncbi.nlm.nih.gov/pubmed/1608978
  20. Ogawa S, Tank DW, Menon R, et al.
    Intrinsic signal changes accompanying sensory stimulation: functional brain mapping with magnetic resonance imaging. Proc Natl Acad Sci U S A 1992; 89:5951–5955.
    http://www.ncbi.nlm.nih.gov/pubmed/1631079
  21. Cheng DT, Knight DC, Smith CN, et al.
    Functional MRI of human amygdala activity during Pavlovian fear conditioning: stimulus processing versus response expression. Behav Neurosci 2003; 117:3–10.
    http://www.ncbi.nlm.nih.gov/pubmed/12619902
  22. Critchley HD.
    The human cortex responds to an interoceptive challenge. Proc Natl Acad Sci USA 2004; 101:6333–6334.
    http://www.ncbi.nlm.nih.gov/pubmed/15096592
  23. Topolovec JC, Gati JS, Menon RS, Shoemaker JK, Cechetto DF.
    Human cardiovascular and gustatory brainstem sites observed by functional magnetic resonance imaging. J Comp Neurol 2004; 471:446–461.
    http://www.ncbi.nlm.nih.gov/pubmed/15022263
  24. Woo MA, Macey PM, Keens PT, et al.
    Functional abnormalities in brain areas that mediate autonomic nervous system control in advanced heart failure. J Card Fail 2005; 11:437–446.
    http://www.ncbi.nlm.nih.gov/pubmed/16105635