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Thessaloniki, March 16, 2019 Filippos Triposkiadis, MD, FESC, FACC Professor of Cardiology Director, Department of Cardiology Larissa University Hospital Larissa, Greece Brain and Heart
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
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
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
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
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
DeSimone CV, et al. J Am Coll Cardiol 2017; 70:1173–82
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
DeSimone CV, et al. J Am Coll Cardiol 2017; 70:1173–82
Cerebral Amyloid Angiopathy and Atrial Fibrillation : Increased Risk of Thromboembolism
and Intracerebral Hemorrhage
1. Fundamentals of Brain-Heart Interaction
2. Small vessel disease
3. Takotsubo (stress) cardiomyopathy
4. Alzheimer’s disease
6. Cognitive dysfunction in heart failure
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
3. Takotsubo (stress) cardiomyopathy
4. Alzheimer’s disease
5. Cognitive dysfunction in heart failure
6. Conclusions
Outline
Production, Degradation, and Deposition of Amyloid β in Cortical Arteries
DeSimone CV, et al. J Am Coll Cardiol 2017; 70:1173–82
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
3. Takotsubo (stress) cardiomyopathy
4. Alzheimer’s disease
5. Cognitive dysfunction in heart failure
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
2. Small vessel disease
3. Takotsubo (stress) cardiomyopathy
4. Alzheimer’s disease
5. Cognitive dysfunction in heart failure
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
Troncone L, et al. J Am Coll Cardiol 2016; 68:2395-2407
Alzheimer’s Disease
Troncone L, et al. J Am Coll Cardiol 2016; 68:2395-2407
Amyloid β Is Increased in Alzheimer's Disease Hearts
Troncone L, et al. J Am Coll Cardiol 2016; 68:2395-2407
