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Ghouse A, Pfurtscheller G, Schwarz G, Valenza G. Uncovering Hemispheric Asymmetry and Directed Oscillatory Brain-Heart Interplay in Anxiety Processing: An fMRI Study. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1984-1993. [PMID: 38748531 DOI: 10.1109/tnsre.2024.3401577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Brain-heart interactions (BHI) are critical for generating and processing emotions, including anxiety. Understanding specific neural correlates would be instrumental for greater comprehension and potential therapeutic interventions of anxiety disorders. While prior work has implicated the pontine structure as a central processor in cardiac regulation in anxiety, the distributed nature of anxiety processing across the cortex remains elusive. To address this, we performed a whole-brain-heart analysis using the full frequency directed transfer function to study resting-state spectral differences in BHI between high and low anxiety groups undergoing fMRI scans. Our findings revealed a hemispheric asymmetry in low-frequency interplay (0.05 Hz - 0.15 Hz) characterized by ascending BHI to the left insula and descending BHI from the right insula. Furthermore, we provide evidence supporting the "pacemaker hypothesis", highlighting the pons' function in regulating cardiac activity. Higher frequency interplay (0.2 Hz - 0.4Hz) demonstrate a preference for ascending interactions, particularly towards ventral prefrontal cortical activity in high anxiety groups, suggesting the heart's role in triggering a cognitive response to regulate anxiety. These findings highlight the impact of anxiety on BHI, contributing to a better understanding of its effect on the resting-state fMRI signal, with further implications for potential therapeutic interventions in treating anxiety disorders.
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Catrambone V, Candia‐Rivera D, Valenza G. Intracortical brain-heart interplay: An EEG model source study of sympathovagal changes. Hum Brain Mapp 2024; 45:e26677. [PMID: 38656080 PMCID: PMC11041380 DOI: 10.1002/hbm.26677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/18/2024] [Accepted: 03/23/2024] [Indexed: 04/26/2024] Open
Abstract
The interplay between cerebral and cardiovascular activity, known as the functional brain-heart interplay (BHI), and its temporal dynamics, have been linked to a plethora of physiological and pathological processes. Various computational models of the brain-heart axis have been proposed to estimate BHI non-invasively by taking advantage of the time resolution offered by electroencephalograph (EEG) signals. However, investigations into the specific intracortical sources responsible for this interplay have been limited, which significantly hampers existing BHI studies. This study proposes an analytical modeling framework for estimating the BHI at the source-brain level. This analysis relies on the low-resolution electromagnetic tomography sources localization from scalp electrophysiological recordings. BHI is then quantified as the functional correlation between the intracortical sources and cardiovascular dynamics. Using this approach, we aimed to evaluate the reliability of BHI estimates derived from source-localized EEG signals as compared with prior findings from neuroimaging methods. The proposed approach is validated using an experimental dataset gathered from 32 healthy individuals who underwent standard sympathovagal elicitation using a cold pressor test. Additional resting state data from 34 healthy individuals has been analysed to assess robustness and reproducibility of the methodology. Experimental results not only confirmed previous findings on activation of brain structures affecting cardiac dynamics (e.g., insula, amygdala, hippocampus, and anterior and mid-cingulate cortices) but also provided insights into the anatomical bases of brain-heart axis. In particular, we show that the bidirectional activity of electrophysiological pathways of functional brain-heart communication increases during cold pressure with respect to resting state, mainly targeting neural oscillations in theδ $$ \delta $$ ,β $$ \beta $$ , andγ $$ \gamma $$ bands. The proposed approach offers new perspectives for the investigation of functional BHI that could also shed light on various pathophysiological conditions.
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Affiliation(s)
- Vincenzo Catrambone
- Neurocardiovascular Intelligence Laboratory & Department of Information Engineering & Bioengineering and Robotics Research Center, E. Piaggio, School of EngineeringUniversity of PisaPisaItaly
| | - Diego Candia‐Rivera
- Sorbonne Université, Paris Brain Institute (ICM), INRIA, CNRS, INSERM, AP‐HP, Hôpital Pitié‐SalpêtriŕeParisFrance
| | - Gaetano Valenza
- Neurocardiovascular Intelligence Laboratory & Department of Information Engineering & Bioengineering and Robotics Research Center, E. Piaggio, School of EngineeringUniversity of PisaPisaItaly
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Pfurtscheller G, Rassler B, Schwarz G, Klimesch W. Scan-associated anxiety (scanxiety): the enigma of emotional breathing oscillations at 0.32 Hz (19 bpm). Front Neurosci 2024; 18:1384993. [PMID: 38638691 PMCID: PMC11025454 DOI: 10.3389/fnins.2024.1384993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024] Open
Abstract
MRI-related anxiety in healthy participants is often characterized by a dominant breathing frequency at around 0.32 Hz (19 breaths per minute, bpm) at the beginning but in a few cases also at the end of scanning. Breathing waves at 19 bpm are also observed in patients with anxiety independently of the scanned body part. In patients with medically intractable epilepsy and intracranial electroencephalography (iEEG), spontaneous breathing through the nose varied between 0.24 and 0.37 Hz (~19 bpm). Remarkable is the similarity of the observed breathing rates at around 0.32 Hz during different types of anxiety states (e.g., epilepsy, cancer, claustrophobia) with the preferred breathing frequency of 0.32 Hz (19 bpm), which is predicted by the binary hierarchy model of Klimesch. This elevated breathing frequency most likely reflects an emotional processing state, in which energy demands are minimized due to a harmonic coupling ratio with other brain-body oscillations.
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Affiliation(s)
- Gert Pfurtscheller
- Institute of Neural Engineering, Graz University of Technology, Graz, Austria
| | - Beate Rassler
- Carl-Ludwig-Institute of Physiology, University of Leipzig, Leipzig, Germany
| | - Gerhard Schwarz
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Wolfgang Klimesch
- Centre of Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
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Catrambone V, Zallocco L, Ramoretti E, Mazzoni MR, Sebastiani L, Valenza G. Integrative neuro-cardiovascular dynamics in response to test anxiety: A brain-heart axis study. Physiol Behav 2024; 276:114460. [PMID: 38215864 DOI: 10.1016/j.physbeh.2024.114460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/08/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024]
Abstract
Test anxiety (TA), a recognized form of social anxiety, is the most prominent cause of anxiety among students and, if left unmanaged, can escalate to psychiatric disorders. TA profoundly impacts both central and autonomic nervous systems, presenting as a dual manifestation of cognitive and autonomic components. While limited studies have explored the physiological underpinnings of TA, none have directly investigated the intricate interplay between the CNS and ANS in this context. In this study, we introduce a non-invasive, integrated neuro-cardiovascular approach to comprehensively characterize the physiological responses of 27 healthy subjects subjected to test anxiety induced via a simulated exam scenario. Our experimental findings highlight that an isolated analysis of electroencephalographic and heart rate variability data fails to capture the intricate information provided by a brain-heart axis assessment, which incorporates an analysis of the dynamic interaction between the brain and heart. With respect to resting state, the simulated examination induced a decrease in the neural control onto heartbeat dynamics at all frequencies, while the studying condition induced a decrease in the ascending heart-to-brain interplay at EEG oscillations up to 12Hz. This underscores the significance of adopting a multisystem perspective in understanding the complex and especially functional directional mechanisms underlying test anxiety.
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Affiliation(s)
- Vincenzo Catrambone
- Neurocardiovascular Intelligence Laboratory, Department of Information Engineering & Bioengineering and Robotics Research Center E. Piaggio, School of Engineering, University of Pisa, Pisa, Italy.
| | - Lorenzo Zallocco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Eleonora Ramoretti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Maria Rosa Mazzoni
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Laura Sebastiani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; Institute of Information Science and Technologies A. Faedo, ISTI-CNR, Pisa, Italy
| | - Gaetano Valenza
- Neurocardiovascular Intelligence Laboratory, Department of Information Engineering & Bioengineering and Robotics Research Center E. Piaggio, School of Engineering, University of Pisa, Pisa, Italy
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Sidorenko L, Sidorenko I, Gapelyuk A, Wessel N. Pathological Heart Rate Regulation in Apparently Healthy Individuals. ENTROPY (BASEL, SWITZERLAND) 2023; 25:1023. [PMID: 37509970 PMCID: PMC10378381 DOI: 10.3390/e25071023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
Cardiovascular diseases are the leading cause of morbidity and mortality in adults worldwide. There is one common pathophysiological aspect present in all cardiovascular diseases-dysfunctional heart rhythm regulation. Taking this aspect into consideration for cardiovascular risk predictions opens important research perspectives, allowing for the development of preventive treatment techniques. The aim of this study was to find out whether certain pathologically appearing signs in the heart rate variability (HRV) of an apparently healthy person, even with high HRV, can be defined as biomarkers for a disturbed cardiac regulation and whether this can be treated preventively by a drug-free method. This multi-phase study included 218 healthy subjects of either sex, who consecutively visited the physician at Gesundheit clinic because of arterial hypertension, depression, headache, psycho-emotional stress, extreme weakness, disturbed night sleep, heart palpitations, or chest pain. In study phase A, baseline measurement to identify individuals with cardiovascular risks was done. Therefore, standard HRV, as well as the new cardiorhythmogram (CRG) method, were applied to all subjects. The new CRG analysis used here is based on the recently introduced LF drops and HF counter-regulation. Regarding the mechanisms of why these appear in a steady-state cardiorhythmmogram, they represent non-linear event-based dynamical HRV biomarkers. The next phase of the study, phase B, tested whether the pathologically appearing signs identified via CRG in phase A could be clinically influenced by drug-free treatment. In order to validate the new CRG method, it was supported by non-linear HRV analysis in both phase A and in phase B. Out of 218 subjects, the pathologically appearing signs could be detected in 130 cases (60%), p < 0.01, by the new CRG method, and by the standard HRV analysis in 40 cases (18%), p < 0.05. Thus, the CRG method was able to detect 42% more cases with pathologically appearing cardiac regulation. In addition, the comparative CRG analysis before and after treatment showed that the pathologically appearing signs could be clinically influenced without the use of medication. After treatment, the risk group decreased eight-fold-from 130 people to 16 (p < 0.01). Therefore, progression of the detected pathological signs to structural cardiac pathology or arrhythmia could be prevented in most of the cases. However, in the remaining risk group of 16 apparently healthy subjects, 8 people died due to all-cause mortality. In contrast, no other subject in this study has died so far. The non-linear parameter which is able to quantify the changes in CRGs before versus after treatment is FWRENYI4 (symbolic dynamic feature); it decreased from 2.85 to 2.53 (p < 0.001). In summary, signs of pathological cardiac regulation can be identified by the CRG analysis of apparently healthy subjects in the early stages of development of cardiac pathology. Thus, our method offers a sensitive biomarker for cardiovascular risks. The latter can be influenced by non-drug treatments (acupuncture) to stop the progression into structural cardiac pathologies or arrhythmias in most but not all of the patients. Therefore, this could be a real and easy-to-use supplemental method, contributing to primary prevention in cardiology.
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Affiliation(s)
- Ludmila Sidorenko
- Department of Molecular Biology and Human Genetics, State University of Medicine and Pharmacy, "Nicolae Testemitanu", Stefan cel Mare Str. 165, MD-2004 Chisinau, Moldova
| | - Irina Sidorenko
- Medical Center "Gesundheit", Mihai Kogalniceanu Str. 45/2, MD-2009 Chisinau, Moldova
| | - Andrej Gapelyuk
- Cardiovascular Physics, Humboldt-Universität zu Berlin, D-10099 Berlin, Germany
| | - Niels Wessel
- Cardiovascular Physics, Humboldt-Universität zu Berlin, D-10099 Berlin, Germany
- MSB Medical School Berlin GmbH, D-14197 Berlin, Germany
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Valenza G. Depression as a cardiovascular disorder: central-autonomic network, brain-heart axis, and vagal perspectives of low mood. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1125495. [PMID: 37260560 PMCID: PMC10228690 DOI: 10.3389/fnetp.2023.1125495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/04/2023] [Indexed: 06/02/2023]
Abstract
If depressive symptoms are not caused by the physiological effects of a substance or other medical or neurological conditions, they are generally classified as mental disorders that target the central nervous system. However, recent evidence suggests that peripheral neural dynamics on cardiovascular control play a causal role in regulating and processing emotions. In this perspective, we explore the dynamics of the Central-Autonomic Network (CAN) and related brain-heart interplay (BHI), highlighting their psychophysiological correlates and clinical symptoms of depression. Thus, we suggest that depression may arise from dysregulated cardiac vagal and sympathovagal dynamics that lead to CAN and BHI dysfunctions. Therefore, treatments for depression should target the nervous system as a whole, with particular emphasis on regulating vagal and BHI dynamics.
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Rassler B, Blinowska K, Kaminski M, Pfurtscheller G. Analysis of Respiratory Sinus Arrhythmia and Directed Information Flow between Brain and Body Indicate Different Management Strategies of fMRI-Related Anxiety. Biomedicines 2023; 11:biomedicines11041028. [PMID: 37189642 DOI: 10.3390/biomedicines11041028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Respiratory sinus arrhythmia (RSA) denotes decrease of cardiac beat-to-beat intervals (RRI) during inspiration and RRI increase during expiration, but an inverse pattern (termed negative RSA) was also found in healthy humans with elevated anxiety. It was detected using wave-by-wave analysis of cardiorespiratory rhythms and was considered to reflect a strategy of anxiety management involving the activation of a neural pacemaker. Results were consistent with slow breathing, but contained uncertainty at normal breathing rates (0.2–0.4 Hz). Objectives and methods: We combined wave-by-wave analysis and directed information flow analysis to obtain information on anxiety management at higher breathing rates. We analyzed cardiorespiratory rhythms and blood oxygen level-dependent (BOLD) signals from the brainstem and cortex in 10 healthy fMRI participants with elevated anxiety. Results: Three subjects with slow respiratory, RRI, and neural BOLD oscillations showed 57 ± 26% negative RSA and significant anxiety reduction by 54 ± 9%. Six participants with breathing rate of ~0.3 Hz showed 41 ± 16% negative RSA and weaker anxiety reduction. They presented significant information flow from RRI to respiration and from the middle frontal cortex to the brainstem, which may result from respiration-entrained brain oscillations, indicating another anxiety management strategy. Conclusion: The two analytical approaches applied here indicate at least two different anxiety management strategies in healthy subjects.
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Pfurtscheller G, Kaminski M, J Blinowska K, Rassler B, Schwarz G, Klimesch W. Respiration-entrained brain oscillations in healthy fMRI participants with high anxiety. Sci Rep 2023; 13:2380. [PMID: 36765092 PMCID: PMC9918542 DOI: 10.1038/s41598-023-29482-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Brain-body interactions can be studied by using directed coupling measurements of fMRI oscillations in the low (0.1-0.2 Hz) and high frequency bands (HF; 0.2-0.4 Hz). Recently, a preponderance of oscillations in the information flow between the brainstem and the prefrontal cortex at around 0.15/0.16 Hz was shown. The goal of this study was to investigate the information flow between BOLD-, respiratory-, and heart beat-to-beat interval (RRI) signals in the HF band in healthy subjects with high anxiety during fMRI examinations. A multivariate autoregressive model was concurrently applied to the BOLD signals from the middle frontal gyrus (MFG), precentral gyrus and the brainstem, as well as to respiratory and RRI signals. Causal coupling between all signals was determined using the Directed Transfer Function (DTF). We found a salience of fast respiratory waves with a period of 3.1 s (corresponding to ~ 0.32 Hz) and a highly significant (p < 0.001) top-down information-flow from BOLD oscillations in the MFG to the brainstem. Additionally, there was a significant (p < 0.01) information flow from RRI to respiratory oscillations. We speculate that brain oscillations around 0.32 Hz, triggered by nasal breathing, are projected downwards to the brainstem. Particularly interesting is the driving force of cardiac to respiratory waves with a ratio of 1:1 or 1:2. These results support the binary hierarchy model with preferred respiratory frequencies at 0.32 Hz and 0.16 Hz.
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Affiliation(s)
- Gert Pfurtscheller
- Institute of Neural Engineering, Graz University of Technology, Graz, Austria
| | - Maciej Kaminski
- Faculty of Physics, University of Warsaw, ul. Pasteura 5, 02-093, Warsaw, Poland.
| | - Katarzyna J Blinowska
- Faculty of Physics, University of Warsaw, ul. Pasteura 5, 02-093, Warsaw, Poland
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks. Trojdena 4 St., 02-109, Warsaw, Poland
| | - Beate Rassler
- Carl-Ludwig-Institute of Physiology, University of Leipzig, Leipzig, Germany
| | - Gerhard Schwarz
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Wolfgang Klimesch
- Centre of Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
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