Journal of the American Society of Hypertension
Volume 4, Issue 4 , Pages 174-182 , July 2010

The insular cortex and cardiovascular system: a new insight into the brain-heart axis

  • Michiaki Nagai, MD

      Affiliations

    • Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
    • Shobara City Soryo Clinic, Shobara, Japan
    • ,
  • Satoshi Hoshide, MD

      Affiliations

    • Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
    • ,
  • Kazuomi Kario, MD, PhD, FACP, FACC, FAHA

      Affiliations

    • Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
    • Corresponding Author InformationCorresponding author: Kazuomi Kario, MD, PhD, FACP, FACC, FAHA, Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Yakushiji 3311-1, Shimotsuke, Tochigi 329-0498, Japan. Tel: +81-285-58-7538; fax: +81-285-44-4311.

Received 17 April 2010 ,Accepted 19 May 2010.

References 

  1. Cheung RT, Hachinski V. The insula and cerebrogenic sudden death. Arch Neurol. 2000;57:1685–1688
  2. Hermann DM, Siccoli M, Kirov P, Gugger M, Bassetti CL. Central periodic breathing during sleep in acute ischemic stroke. Stroke. 2007;38:1082–1084
  3. Allport LE, Butcher KS, Baird TA, MacGregor L, Desmond PM, Tress BM, et al. Insular cortical ischemia is independently associated with acute stress hyperglycemia. Stroke. 2004;35:1886–1891
  4. Benarroch EE. The central autonomic network: functional organization, dysfunction, and perspective. Mayo Clin Proc. 1993;68:988–1001
  5. Augustine JR. Circuitry and functional aspects of the insular lobe in primates including humans. Brain Res Rev. 1996;22:229–244
  6. Oppenheimer SM, Cechetto DF. The cardiac chronotropic organization of the rat insular cortex. Brain Res. 1900;533:66–72
  7. Oppenheimer SM, Saleh TM, Wilson JX, Cechetto DF. Plasma and organ catecholamine levels following stimulation of the rat insular cortex. Brain Res. 1992;569:221–228
  8. Oppenheimer SM, Wilson JX, Guiraudon C, Cechetto DF. Insular cortex stimulation produces lethal cardiac arrhythmias: a mechanism of sudden death?. Brain Res. 1991;550:1–12
  9. Zhang ZH, Rashba S, Oppenheimer SM. Insular cortex lesions alter baroreceptor sensitivity in the urethane-anesthetized rat. Brain Res. 1998;813:73–81
  10. Zhang ZH, Dougherty PM, Oppenheimer SM. Characterization of baroreceptor-related neurons in the monkey insular cortex. Brain Res. 1998;796:303–306
  11. Min J, Farooq MU, Greenberg E, Aloka F, Bhatt A, Kassab M, et al. Cardiac dysfunction after left permanent cerebral focal ischemia. The Brain and Heart Connection. Stroke. 2009;40:2560–2563
  12. Oppenheimer SM, Gelb A, Girvin JP, Hachinski VC. Cardiovascular effects of human insular cortex stimulation. Neurology. 1992;42:1727–1732
  13. Critchley HD, Rotshtein P, Nagai Y, O'Doherty J, Mathias CJ, Dolan RJ. Activity in the human brain predicting different heart rate responses to emotional facial expression. Neuroimage. 2005;24:751–762
  14. Napadow V, Dhond R, Conti G, Makris N. Brain correlates of autonomic modulation: Combining heart rate variability with fMRI. Neuroimage. 2008;42:169–177
  15. Lane RD, McRae K, Reiman EM, Chen K, Ahern GL, Thayer JF. Neural correlates of heart rate variability. Neuroimage. 2009;44:213–222
  16. Williamson JW, Fadel PJ, Mitchell JH. New insights into central cardiovascular control during exercise in humans: a central command update. Exp Physiol. 2006;91:51–58
  17. Gianaros PJ, Jennings JR, Sheu LK, Derbyshire SWG, Mattews KA. Heightened functional neural activation to psychological stress covaries with exaggerated blood pressure reactivity. Hypertension. 2007;49:134–140
  18. Ben Salem D, Walker PM, Bejot Y, Aho SL, Tavermier B, Rouaud O, et al. N-acetylaspartate/creatine and choline/creatine ratios in the thalami, insular cortex and white matter as markers of hypertension and cognitive impairment in the elderly. Hypertens Res. 2008;31:1851–1857
  19. Nagai M, Hoshide S, Ishikawa J, Shimada K, Kario K. Insular cortex atrophy as an independent determinant of disrupted diurnal rhythm of ambulatory blood pressure in elderly hypertension. Am J Hypertens. 2009;22:723–729
  20. Zamrini EY, Meador KJ, Loring DW, Nichols FT, Lee GP, Figueroa RE, et al. Unilateral cerebral inactivation produces differential left/right heart rate responses. Neurology. 1990;40:1408–1411
  21. Yoon BW, Morillo CA, Cechetto DF, Hachinski V. Cerebral hemispheric lateralization in cardiac autonomic control. Arch Neurol. 1997;54:741–744
  22. Hilz MJ, Dutsch M, Perrine K, Nelson PK, Rauhut U, Devinsky O. Hemispheric influence on autonomic modulation and baroreflex sensitivity. Ann Neurol. 2001;49:575–584
  23. Eckardt M, Gerlach L, Welter FL. Prolongation of the frequency-corrected QT dispersion following cerebral strokes with involvement of the insula of Reil. Eur Neurol. 1999;42:190–193
  24. Vingerhoets F, Bogousslavsky J, Regli F, Van Melle G. Atrial fibrillation after acute stroke. Stroke. 1993;24:26–30
  25. Abboud H, Berroir S, Labreuche J, Orjuela K, Amarenco P. GENIC Investigators. Insular involvement in brain infarction increases risk for cardiac arrhythmia and death. Ann Neurol. 2006;59:691–699
  26. Christensen H, Boysen G, Christensen AF, Johannesen HH. Insular lesions, ECG abnormalities, and outcome in acute stroke. J Neurol Neurosurg Psychiatry. 2005;76:269–271
  27. Tokgozoglu SL, Batur MK, Top-uoglu MA, Saribas O, Kes S, Oto A. Effects of stroke localization on cardiac autonomic balance and sudden death. Stroke. 1999;30:1307–1311
  28. Colivicchi F, Bassi A, Santini M, Caltagirone C. Cardiac autonomic derangement and arrhythmias in right-sided stroke with insular involvement. Stroke. 2004;35:2094–2098
  29. Colivicchi F, Bassi A, Santini M, Caltagirone C. Prognostic implications of right-sided insular damage, cardiac autonomic derangement, and arrhythmias after ischemic stroke. Stroke. 2005;36:1710–1715
  30. Iltumur K, Yavavli A, Apak I, Ariturk Z, Toprak N. Elevated plasma N-terminal pro-brain natriuretic peptide levels in acute ischemic stroke. Am Heart J. 2006;151:1115–1122
  31. Ay H, Koroshetz WJ, Benner T, Vangel MG, Melinosky C, Arsava EM, et al. Neuroanatomical correlates of stroke-related myocardial injury. Neurology. 2006;66:1325–1329
  32. Laowattana S, Zeger SL, Lima JA, Goodman SN, Wittstein IS, Oppenheimer SM. Left insular stroke is associated with adverse cardiac outcome. Neurology. 2006;66:477–483
  33. Dote K, Sato H, Uchinda AT, Ishihara M. Myocardial stunning due to simultaneous multivessel spasms: a review of 5 cases. J Cardiol. 1991;21:203–214
  34. Yoshimura S, Toyoda K, Ohara T, Nagasawa H, Ohtani N, Kuwashiro T, et al. Takotsubo cardiomyopathy in acute ischemic stroke. Ann Neurol. 2008;64:547–554
  35. Sander D, Klingelhofer J. Changes of circadian blood pressure patterns after hemodynamic and thromboembolic brain infarction. Stroke. 1994;25:1730–1737
  36. Meyer S, Strittmatter M, Fischer C, Georg T, Schmitz B. Lateralization in autonomic dysfunction in ischemic stroke involving the insular cortex. Neuroreport. 2004;15:357–361
  37. Sander D, Winbeck K, Klingelhofer J, Etgen T, Conrad B. Prognostic relevance of pathological sympathetic activation after acute thromboembolic stroke. Neurology. 2001;57:833–838
  38. Sykora M, Diedler J, Rupp A, Turcani P, Steiner T. Impaired baroreceptor reflex sensitivity in acute stroke is associated with insular involvement, but not with carotid atherosclerosis. Stroke. 2009;40:737–742

 Supported by a Research Grant for Cardiovascular Medicine (14-6) from the Ministry of Health, Labor, and Welfare, Japan, and by a Research Grant (C-2) from the Ministry of Education, Science, and Culture, Japan.

 Conflict of interest: none.

PII: S1933-1711(10)00119-1

doi: 10.1016/j.jash.2010.05.001

Journal of the American Society of Hypertension
Volume 4, Issue 4 , Pages 174-182 , July 2010

Article Tools

* Image Usage & Resolution