Behavioural modifications after acute takotsubo reduced salivary cortisol (p<0.004), systemic inflammation (p=0.038), preserved brain connectivity, and improved stress scores.
Does behavioural modification (physical exercise or cognitive behavioural therapy) improve hippocampal volume in patients with acute takotsubo cardiomyopathy?
In patients with acute takotsubo syndrome, behavioural modifications (exercise or CBT) did not affect the primary endpoint of hippocampal volume but altered other brain volumes, maintained functional connectivity, and reduced stress and inflammation responses.
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Abstract Background Takotsubo syndrome is a life-threatening neuro-cardiac emergency typically triggered by stress and subtended by systemic inflammation. We assessed if behavioural modifications are associated with changes in brain structure and function after acute takotsubo. Methods In a multi-centre randomised controlled trial, 71 patients with acute takotsubo cardiomyopathy were randomised 1:1:1 to standard care or behavioural modification through either physical exercise training or cognitive behavioural therapy. All participants underwent structural and functional brain magnetic resonance imaging, echocardiography, post-awakening salivary cortisol and venous blood sampling, and completed patient reported outcomes at baseline and following intervention. Results Participants were 66±9 years and predominantly women (91%). The primary outcome (hippocampal volume) was unaffected by either behavioural modification. Both physical exercise and cognitive behavioural therapy decreased total cortical volume (p=0.03 and 0.01, respectively) and right insular volume (p=0.046 and 0.004, respectively). In addition, cognitive behavioural therapy increased cerebral white matter, decreased grey matter (p=0.009 and 0.014 respectively), improved perceived stress score (p=0.04) and decreased systemic inflammation (p=0.038). Behavioural modification groups maintained functional connectivity whilst insular and amygdala functional connectivity declined in standard care group (p0.05). Both behavioural modification interventions decreased post-awakening salivary cortisol stress responses (p0.004). There was comparable cardiac function recovery across groups. Conclusions After acute takotsubo syndrome, behavioural modifications improve brain volumes, functional connectivity and are associated with reductions in systemic cortisol stress and inflammation responses.
Khan et al. (Sat,) reported a other. Behavioural modifications after acute takotsubo reduced salivary cortisol (p<0.004), systemic inflammation (p=0.038), preserved brain connectivity, and improved stress scores.