Brain and Heart - Livemedia.gr · Stavrakis S, Po S. Arrhythm Electrophysiol Rev 2017; 6:186-190...

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Thessaloniki, March 16, 2019

Filippos Triposkiadis, MD, FESC, FACCProfessor of CardiologyDirector, Department of CardiologyLarissa University HospitalLarissa, Greece

Brain and Heart

1. Fundamentals of brain-heart interaction

2. Small vessel disease

3. Takotsubo (stress) cardiomyopathy

4. Alzheimer’s disease

5. Cognitive dysfunction in heart failure

6. Conclusions

Outline

6. Conclusions

Outline

Gorelick PB, et al. Stroke 2017; 48:e284-e303

Determinants of Optimal Brain Health

Gorelick PB, et al. Stroke 2017;48:e284-e303

The Neurovascular Unit

Huang WA, et al. Card Electrophysiol Clin 2017; 9:665–679

Cardiac Neural Control

Stavrakis S, Po S. Arrhythm Electrophysiol Rev 2017; 6:186-190

Intrinsic Cardiac Autonomic Nervous System: The Ganglionated Plexi

Triposkiadis F, et al. J Am Coll Cardiol 2009;54:1747–62

Sympathetic Cardiovascular Control

Nervous Pathways Involved in the Vagal Control of the Heart

Bibevski S, Dunlap ME. Heart Fail Rev 2011; 16:129-35

Intracardiac fat pad

6. Conclusions

Outline

Berry C, et al. J Am Heart Assoc 2019; 8:e011104

Microvascular Disease is a Multisystem Disorder

De Bruyne, et al. J Am Coll Cardiol 2016; 67:1170-1172

Coronary Macrocirculationand Microcirculation

Ford TJ, et al.

Heart 2018; 104:284-292

Diagnosis of MicrovascularAngina

Berry C, et al. J Am Heart Assoc 2019; 8:e011104

Microvascular Angina and Acute Ischemic Stroke

Key Features of the CerebralArteriolar and Capillary Wall

Wardlaw JM, et al. Lancet Neurol 2013; 12:483-97

Pathology Due to Small Vessel Disease in the Aging Brain

DeSimone CV, et al. J Am Coll Cardiol 2017; 70:1173–82

Hypertensive Small Vessel Disease:from Arteriolosclerosis to Fibrinoid Necrosis

Wardlaw JM, et al. Lancet Neurol 2013; 12:483-97

Hypertensive Small Vessel Disease Imaging

Tsai HH, et al. Journal of Stroke 2018; 20:167-79

Production, Degradation, and Deposition of Amyloid β in Cortical Arteries

Yamada M. Journal of Stroke 2015; 17:17-30

Cerebral Amyloid Angiopathy

Cerebral Amyloid Angiopathy Imaging

Tsai HH, et al. Journal of Stroke 2018; 20:167-79

Cerebral Amyloid Angiopathy and Atrial Fibrillation : Increased Risk of Thromboembolism

and Intracerebral Hemorrhage

1. Fundamentals of Brain-Heart Interaction

7. Conclusions

Outline

The Takotsubo Cardiomyopathy

Templin C, et al. N Engl J Med 2015; 373:929-938

Medina de Chazal, et al. J Am Coll Cardiol 2018; 72:1955-71

Pathophysiology of the Takotsubo Cardiomyopathy

Wittstein IS, et al. N Engl J Med 2005; 352:539–48

Plasma Catecholamines in Takotsubo Cardiomyopathy vs. Myocardial Infarction

Lyon AR, et al. Nat Clin Pract Cardiovasc Med 2008; 5:22–9

Takotsubo Cardiomyopathy: Effect ofCatecholamines on Myocardial Contractility

Epinephrine-β2-Gi signallingNEGATIVELY INOTROPIC

ANTIAPOPTOTIC

Norepinephrine-β1-Gs signallingPOSITIVELY INOTROPIC

PROAPOPTOTIC

Sympathetic nerve

Structural Alterations of the Limbic System in Takotsubo Cardiomyopathy

Hiestand T, et al. J Am Coll Cardiol 2018; 71:809-811

Takotsubo Cardiomyopathy vs.Neurogenic Stunned Myocardium

Ibrahim MS, et al. Neurocrit Care 2018 Nov 27

Medina de Chazal, et al. J Am Coll Cardiol 2018; 72:1955-71

Acute Treatment of Takotsubowith Hemodynamic Compromise

1. Mechanism of death precipitated by fear

2. Fundamentals of brain-heart Interaction

6. Conclusions

Outline

Production, Degradation, and Deposition of Amyloid β in Cortical Arteries

Normal Alzheimer

Vascular Hypothesis of Alzheimer’s Disease

Tublin JM, et al. Circ Res 2019; 124:142-149

Cardiac Abnormalities in Alzheimer’s Disease

32 patients with AD and 34 controls matched by age and sex, all of whom were free from cardiac or systemic diseases. A clinical evaluation, an electrocardiogram, and an echocardiogram were performed in all subjects. Furthermore, patients with AD underwent genetic analyses (of the PSEN1, PSEN2, APP, and APOE genes).

Sanna GD, et al. J Am Coll Cardiol HF 2019; 7:121–8

Amyloid β Is Increased in Alzheimer's Disease Hearts

Troncone L, et al. J Am Coll Cardiol 2016; 68:2395-2407

1. Mechanism of death precipitated by fear

2. Fundamentals of brain-heart Interaction

6. Conclusions

Outline

Wolters FJ, et al. Alzheimer’s & Dementia 2018; 14:1493-1504

Associations of Heart Failure with Dementia and Alzheimer’s Disease

Alzheimer’s Disease All-Cause Dementia

Brain Magnetic Resonance ImagingAbnormalities in Heart Failure

Vogels RL, et al. Eur J Heart Fail 2007; 9:1003-9

Structural Brain Abnormalities in HF Patients vs. Age- and Sex-Matched Controls

Frey A, et al. JACC Heart Fail 2018 ; 6:583-92

A total of 148 systolic and diastolic HF patients (mean age 64±11 years; 16% female; mean left ventricular ejection fraction 43 ± 8%) were extensively evaluated within 2 days by cardiological, neurological, and neuropsychological testing and brain magnetic resonance imaging (MRI). A total of 288 healthy, sex- and age-matched subjects sampled from the Austrian Stroke Prevention Study served as MRI controls.

Medial Temporal Lobe Atrophy vs. Cognitive Deficit

Frey A, et al. JACC Heart Fail 2018 ; 6:583-92

Celutkiene J, et al. Cardiac Failure Review 2016; 2:106-109

Pathogenic Links of Heart Failureand Cognitive Dysfunction

Heart Failure

Cognitive Dysfunction

HF-Induced Brain Injury: Characteristics and Basic Approach

Havakuk O, et al. J Am Coll Cardiol 2017; 69:1609–16

Managementof HF InducedBrain Injury

Havakuk O, et al. J Am Coll Cardiol 2017; 69:1609–16

Exercise for Cognitive Brain Health in Aging

Gomes-Osman J, et al. Neurology: Clinical Practice 2018; 8:1-9

1. Fundamentals of Brain-Heart Interaction

6. Conclusions

Outline

• Brain affects the heart and vice verse. Brain and cardiac dysfunction often coexist.

• Abnormalities in cerebral blood flow are common in patients with microvascular angina and small vessel disease may be considered a multisystem disorder.

• Autonomic-limbic integration plays an important role in the pathophysiology of the Takotsubo syndrome.

• Vascular dysfunction contributes to the development of Alzheimer’s disease, the commonest cause of dementia.

• Heart failure (HF) is a risk factor for the development of dementia.

• Exercise programs on top of standard medical treatment may delay or reverse cognitive impairment in HF patients.

TTS-Related Hypoconnectivity among CNS Structures

Templin C, et al. Eur Heart J 2019, 5 March

Head to Heart Connectionin Alzheimer’s Disease

Tublin JM, et al. Circ Res 2019; 124:142-149

Alzheimer’sDisease

HeartFailure

Aβ-Pre-amyloid Oligomers in Myocytes and Interstitial Tissue

Alzheimer’s Disease

Amyloid β Is Increased in Alzheimer's Disease Hearts

Brain and Heart - Livemedia.gr · Stavrakis S, Po S. Arrhythm Electrophysiol Rev 2017; 6:186-190...

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