Heart-brain interactions shape somatosensory perception and evoked potentials

Interoceptive signals shape the earliest markers and neural pathway to awareness at the visual threshold

Variations in interoceptive signals from the baroreceptors (BRs) across the cardiac and respiratory cycle can modulate cortical excitability and so affect awareness. It remains debated at what stages of processing they affect awareness-related event-related potentials (ERPs) in different sensory modalities. We investigated the influence of the cardiac (systole/diastole) and the respiratory (inhalation/exhalation) phase on awareness-related ERPs. Subjects discriminated visual threshold stimuli while their electroencephalogram, electrocardiogram, and respiration were simultaneously recorded. We compared ERPs and their intracranial generators for stimuli classified correctly with and without awareness as a function of the cardiac and respiratory phase. Cyclic variations of interoceptive signals from the BRs modulated both the earliest electrophysiological markers and the trajectory of brain activity when subjects became aware of the stimuli: an early sensory component (P1) was the earliest marker of awareness for low (diastole/inhalation) and a perceptual component (visual awareness negativity) for high (systole/exhalation) BR activity, indicating that BR signals interfere with the sensory processing of the visual input. Likewise, activity spread from the primary visceral cortex (posterior insula) to posterior parietal cortices during high and from associative interoceptive centers (anterior insula) to the prefrontal cortex during low BR activity. Consciousness is thereby resolved in cognitive/associative regions when BR is low and in perceptual centers when it is high. Our results suggest that cyclic fluctuations of BR signaling affect both the earliest markers of awareness and the brain processes underlying conscious awareness.

Interoception, network physiology and the emergence of bodily self-awareness

The interplay between the brain and interoceptive signals is key in maintaining internal balance and orchestrating neural dynamics, encompassing influences on perceptual and self-awareness. Central to this interplay is the differentiation between the external world, others and the self, a cornerstone in the construction of bodily self-awareness. This review synthesizes physiological and behavioral evidence illustrating how interoceptive signals can mediate or influence bodily self-awareness, by encompassing interactions with various sensory modalities. To deepen our understanding of the basis of bodily self-awareness, we propose a network physiology perspective. This approach explores complex neural computations across multiple nodes, shifting the focus from localized areas to large-scale neural networks. It examines how these networks operate in parallel with and adapt to changes in visceral activities. Within this framework, we propose to investigate physiological factors that disrupt bodily self-awareness, emphasizing the impact of interoceptive pathway disruptions, offering insights across several clinical contexts. This integrative perspective not only can enhance the accuracy of mental health assessments but also paves the way for targeted interventions.

Listen to your heart: Trade-off between cardiac interoceptive processing and visual exteroceptive processing

Internal bodily signals, such as heartbeats, can influence conscious perception of external sensory information. Spontaneous shifts of attention between interoception and exteroception have been proposed as the underlying mechanism, but direct evidence is lacking. Here, we used steady-state visual evoked potential (SSVEP) frequency tagging to independently measure the neural processing of visual stimuli that were concurrently presented but varied in heartbeat coupling in healthy participants. Although heartbeat coupling was irrelevant to participants' task of detecting brief color changes, we found decreased SSVEPs for systole-coupled stimuli and increased SSVEPs for diastole-coupled stimuli, compared to non-coupled stimuli. These results suggest that attentional and representational resources allocated to visual stimuli vary according to fluctuations in cardiac-related signals across the cardiac cycle, reflecting spontaneous and immediate competition between cardiac-related signals and visual events. Furthermore, frequent coupling of visual stimuli with stronger cardiac-related signals not only led to a larger heartbeat evoked potential (HEP) but also resulted in a smaller color change evoked N2 component, with the increase in HEP amplitude associated with a decrease in N2 amplitude. These findings indicate an overall or longer-term increase in brain resources allocated to the internal domain at the expense of reduced resources available for the external domain. Our study highlights the dynamic reallocation of limited processing resources across the internal-external axis and supports the trade-off between interoception and exteroception.

Cardiac cycle modulates social pain

Social pain is a painful feeling evoked by social rejection, exclusion, or the loss of other important people. Previous research suggests that physical pain is reduced by increased signals from baroreceptors that monitor blood pressure. This pre-registered study investigated whether social pain is attenuated by increased baroafferent signals, as observed in physical pain. Given that baroafferent signals increase during cardiac systole and decrease during diastole, we hypothesized that feelings of pain induced by social rejection would be lower when exclusion events are presented at the cardiac systole than when they are presented at the diastole. Participants completed the cyberball task, a computerized ball-tossing game involving two other players. In the rejection condition, the ball was rarely thrown to the participant, while the other players kept tossing it to each other. Throws between other players were defined as exclusion events and were presented either at the cardiac systole (a systole condition) or at the diastole (a diastole condition). We found that exclusion events evoked significantly less social pain in the systole condition than in the diastole condition. Furthermore, the effects of cardiac cycle were more pronounced in participants with higher heart rate variability than those with lower heart rate variability. Our results suggest that cardiac afferent signals contribute not only to physical pain but also to social pain.

New recognition of the heart-brain axis and its implication in the pathogenesis and treatment of PTSD

Post-traumatic stress disorder (PTSD) is a complex psychological disorder provoked by distressing experiences, and it remains without highly effective intervention strategies. The exploration of PTSD's underlying mechanisms is crucial for advancing diagnostic and therapeutic approaches. Current studies primarily explore PTSD through the lens of the central nervous system, investigating concrete molecular alterations in the cerebral area and neural circuit irregularities. However, the body's response to external stressors, particularly the changes in cardiovascular function, is often pronounced, evidenced by notable cardiac dysfunction. Consequently, examining PTSD with a focus on cardiac function is vital for the early prevention and targeted management of the disorder. This review undertakes a comprehensive literature analysis to detail the alterations in brain and heart structures and functions associated with PTSD. It also synthesizes potential mechanisms of heart-brain axis interactions relevant to the development of PTSD. Ultimately, by considering cardiac function, this review proposes novel perspectives for PTSD's prophylaxis and therapy.

Triggered by your heart: Effects of cardioafferent traffic and stress on automatic responses in a Simon task

Variations in cardioafferent traffic are relayed to the brain via arterial baroreceptors and have been shown to modulate perceptual processing. However, less is known about the cognitive-behavioral consequences of these effects and their role during stress. Here, we investigated in how far automatic responses during the Simon task were modulated by exposure to a laboratory stressor and the different phases of the cardiac cycle. In this study, 30 participants performed three blocks of a combined horizontal and vertical Simon task, which is characterized by either sensorimotor or cognitive response conflicts, respectively. Before each block, subjects were exposed to both the cold pressor test (CPT) and a control condition according to a within-subjects design. Target stimuli were presented during either systole or diastole. Behavioral and EEG-correlates of task processing were assessed along with subjective, cardiovascular, and endocrine measures of stress. The stress induction was successful yielding significant increases in all these measures compared to control. Moreover, we found the expected Simon effects: in incompatible compared to compatible trials performance was decreased and LRP latency as well as anterior N2 area increased. Importantly, accuracy was improved in compatible but reduced in incompatible trials during systole vs. diastole but only in the horizontal Simon condition. Stress dampened N2 area, however, no interactions with cardiac cycle were evident. These results indicate a faciliatory effect of cardioafferent traffic on automated sensorimotor processes.

Impaired brain-heart axis in focal epilepsy: Alterations in information flow and implications for seizure dynamics

This study delves into functional brain-heart interplay (BHI) dynamics during interictal periods before and after seizure events in focal epilepsy. Our analysis focuses on elucidating the causal interaction between cortical and autonomic nervous system (ANS) oscillations, employing electroencephalography and heart rate variability series. The dataset for this investigation comprises 47 seizure events from 14 independent subjects, obtained from the publicly available Siena Dataset. Our findings reveal an impaired brain-heart axis especially in the heart-to-brain functional direction. This is particularly evident in bottom-up oscillations originating from sympathovagal activity during the transition between preictal and postictal periods. These results indicate a pivotal role of the ANS in epilepsy dynamics. Notably, the brain-to-heart information flow targeting cardiac oscillations in the low-frequency band does not display significant changes. However, there are noteworthy changes in cortical oscillations, primarily originating in central regions, influencing heartbeat oscillations in the high-frequency band. Our study conceptualizes seizures as a state of hyperexcitability and a network disease affecting both cortical and peripheral neural dynamics. Our results pave the way for a deeper understanding of BHI in epilepsy, which holds promise for the development of advanced diagnostic and therapeutic approaches also based on bodily neural activity for individuals living with epilepsy.

Two common issues in synchronized multimodal recordings with EEG: Jitter and latency

Multimodal recording using electroencephalogram (EEG) and other biological signals (e.g., muscle activities, eye movement, pupil diameters, or body kinematics data) is ubiquitous in human neuroscience research. However, the precise time alignment of multiple data from heterogeneous sources (i.e., devices) is often arduous due to variable recording parameters of commercially available research devices and complex experimental setups. In this review, we introduced the versatility of a Lab Streaming Layer (LSL)-based application that can overcome two common issues in measuring multimodal data: jitter and latency. We discussed the issues of jitter and latency in multimodal recordings and the benefits of time-synchronization when recording with multiple devices. In addition, a computer simulation was performed to highlight how the millisecond-order jitter readily affects the signal-to-noise ratio of the electrophysiological outcome. Together, we argue that the LSL-based system can be used for research requiring precise time-alignment of datasets. Studies that detect stimulus-induced transient neural responses or test hypotheses regarding temporal relationships of different functional aspects with multimodal data would benefit most from LSL-based systems.

How and Why People Synchronize: An Integrated Perspective

Academic AbstractInterpersonal synchrony, the alignment of behavior and/or physiology during interactions, is a pervasive phenomenon observed in diverse social contexts. Here we synthesize across contexts and behaviors to classify the different forms and functions of synchrony. We provide a concise framework for classifying the manifold forms of synchrony along six dimensions: periodicity, discreteness, spatial similarity, directionality, leader-follower dynamics, and observability. We also distill the various proposed functions of interpersonal synchrony into four interconnected functions: reducing complexity and improving understanding, accomplishing joint tasks, strengthening social connection, and influencing partners' behavior. These functions derive from first principles, emerge from each other, and are accomplished by some forms of synchrony more than others. Effective synchrony flexibly adapts to social goals and more synchrony is not always better. Our synthesis offers a shared framework and language for the field, allowing for better cross-context and cross-behavior comparisons, generating new hypotheses, and highlighting future research directions.

Dissociative Symptoms and Interoceptive Integration

Dissociative symptoms and disorders of dissociation are characterised by disturbances in the experience of the self and the surrounding world, manifesting as a breakdown in the normal integration of consciousness, memory, identity, emotion, and perception. This paper aims to provide insights into dissociative symptoms from the perspective of interoception, the sense of the body's internal physiological state, adopting a transdiagnostic framework.Dissociative symptoms are associated with a blunting of autonomic reactivity and a reduction in interoceptive precision. In addition to the central function of interoception in homeostasis, afferent visceral signals and their neural and mental representation have been shown to shape emotional feeling states, support memory encoding, and contribute to self-representation. Changes in interoceptive processing and disrupted integration of interoceptive signals into wider cognition may contribute to detachment from the body and the world, blunted emotional experience, and altered subjective recall, as experienced by individuals who suffer from dissociation.A better understanding of the role of altered interoceptive integration across the symptom areas of dissociation could thus provide insights into the neurophysiological mechanisms underlying dissociative disorders. As new therapeutic approaches targeting interoceptive processing emerge, recognising the significance of interoceptive mechanisms in dissociation holds potential implications for future treatment targets.

Disrupted interoceptive awareness by auditory distractor: Difficulty inferring the internal bodily states?

Recent studies have associated interoceptive awareness, the perception of internal bodily sensations, with a predictive mechanism of perception across all sensory modalities. According to the framework, volitional attention plays a pivotal role in interoceptive awareness by prioritizing interoceptive sensations over exteroceptive ones. Consequently, it is hypothesized that the presence of irrelevant stimuli would disrupt the attentional modulation and interoceptive awareness, which remains untested. In this study, we investigated if interoceptive awareness is diminished by unrelated auditory distractors to validate the proposed perceptual framework. A total of 30 healthy human volunteers performed the heartbeat counting task both with and without auditory distractors. Additionally, we measured participant's psychophysiological traits related to interoception, including the high-frequency component of heart rate variability (HF-HRV) and trait interoceptive sensibility. The results showed that interoceptive accuracy, confidence, and heartbeat intensity decreased in the presence of distractor sound. Moreover, individuals with higher HF-HRV and a greater tendency to worry about bodily states experienced a more pronounced distractor effect on interoceptive awareness. These results provide support for the perceptual mechanism of interoceptive awareness in terms of the predictive process, highlighting the impact of relative precision across interoceptive and exteroceptive signals on perceptual experiences.

Effects of the cardiac cycle on auditory processing: A preregistered study on mismatch negativity

The systolic and diastolic phases of the cardiac cycle are known to affect perception and cognition differently. Higher order processing tends to be facilitated at systole, whereas sensory processing of external stimuli tends to be impaired at systole compared to diastole. The current study aims to examine whether the cardiac cycle affects auditory deviance detection, as reflected in the mismatch negativity (MMN) of the event-related brain potential (ERP). We recorded the intensity deviance response to deviant tones (70 dB) presented among standard tones (60 or 80 dB, depending on blocks) and calculated the MMN by subtracting standard ERP waveforms from deviant ERP waveforms. We also assessed intensity-dependent N1 and P2 amplitude changes by subtracting ERPs elicited by soft standard tones (60 dB) from ERPs elicited by loud standard tones (80 dB). These subtraction methods were used to eliminate phase-locked cardiac-related electric artifacts that overlap auditory ERPs. The endogenous MMN was expected to be larger at systole, reflecting the facilitation of memory-based auditory deviance detection, whereas the exogenous N1 and P2 would be smaller at systole, reflecting impaired exteroceptive sensory processing. However, after the elimination of cardiac-related artifacts, there were no significant differences between systole and diastole in any ERP components. The intensity-dependent N1 and P2 amplitude changes were not obvious in either cardiac phase, probably because of the short interstimulus intervals. The lack of a cardiac phase effect on MMN amplitude suggests that preattentive auditory processing may not be affected by bodily signals from the heart.

Attention to cardiac sensations enhances the heartbeat-evoked potential during exhalation

Respiration and cardiac activity intricately interact through complex physiological mechanisms. The heartbeat-evoked potential (HEP) is an EEG fluctuation reflecting the cortical processing of cardiac signals. We recently found higher HEP amplitude during exhalation than inhalation during a task involving attention to cardiac sensations. This may have been due to reduced cardiac perception during inhalation and heightened perception during exhalation through attentional mechanisms. To investigate relationships between HEP, attention, and respiration, we introduced an experimental setup that included tasks related to cardiac and respiratory interoceptive and exteroceptive attention. Results revealed HEP amplitude increases during the interoceptive tasks over fronto-central electrodes. When respiratory phases were taken into account, HEP increases were primarily driven by heartbeats recorded during exhalation, specifically during the cardiac interoceptive task, while inhalation had minimal impact. These findings emphasize the role of respiration in cardiac interoceptive attention and could have implications for respiratory interventions to fine-tune cardiac interoception.

Timing along the cardiac cycle modulates neural signals of reward-based learning

Natural fluctuations in cardiac activity modulate brain activity associated with sensory stimuli, as well as perceptual decisions about low magnitude, near-threshold stimuli. However, little is known about the relationship between fluctuations in heart activity and other internal representations. Here we investigate whether the cardiac cycle relates to learning-related internal representations - absolute and signed prediction errors. We combined machine learning techniques with electroencephalography with both simple, direct indices of task performance and computational model-derived indices of learning. Our results demonstrate that just as people are more sensitive to low magnitude, near-threshold sensory stimuli in certain cardiac phases, so are they more sensitive to low magnitude absolute prediction errors in the same cycles. However, this occurs even when the low magnitude prediction errors are associated with clearly suprathreshold sensory events. In addition, participants exhibiting stronger differences in their prediction error representations between cardiac cycles exhibited higher learning rates and greater task accuracy.

Exploring the neural underpinnings of chord prediction uncertainty: an electroencephalography (EEG) study

Predictive processing in the brain, involving interaction between interoceptive (bodily signal) and exteroceptive (sensory) processing, is essential for understanding music as it encompasses musical temporality dynamics and affective responses. This study explores the relationship between neural correlates and subjective certainty of chord prediction, focusing on the alignment between predicted and actual chord progressions in both musically appropriate chord sequences and random chord sequences. Participants were asked to predict the final chord in sequences while their brain activity was measured using electroencephalography (EEG). We found that the stimulus preceding negativity (SPN), an EEG component associated with predictive processing of sensory stimuli, was larger for non-harmonic chord sequences than for harmonic chord progressions. Additionally, the heartbeat evoked potential (HEP), an EEG component related to interoceptive processing, was larger for random chord sequences and correlated with prediction certainty ratings. HEP also correlated with the N5 component, found while listening to the final chord. Our findings suggest that HEP more directly reflects the subjective prediction certainty than SPN. These findings offer new insights into the neural mechanisms underlying music perception and prediction, emphasizing the importance of considering auditory prediction certainty when examining the neural basis of music cognition.

Cardio-audio synchronization elicits neural and cardiac surprise responses in human wakefulness and sleep

The human brain can encode auditory regularities with fixed sound-to-sound intervals and with sound onsets locked to cardiac inputs. Here, we investigated auditory and cardio-audio regularity encoding during sleep, when bodily and environmental stimulus processing may be altered. Using electroencephalography and electrocardiography in healthy volunteers (N = 26) during wakefulness and sleep, we measured the response to unexpected sound omissions within three regularity conditions: synchronous, where sound and heartbeat are temporally coupled, isochronous, with fixed sound-to-sound intervals, and a control condition without regularity. Cardio-audio regularity encoding manifested as a heartbeat deceleration upon omissions across vigilance states. The synchronous and isochronous sequences induced a modulation of the omission-evoked neural response in wakefulness and N2 sleep, the former accompanied by background oscillatory activity reorganization. The violation of cardio-audio and auditory regularity elicits cardiac and neural responses across vigilance states, laying the ground for similar investigations in altered consciousness states such as coma and anaesthesia.

Clinical potential of sensory neurites in the heart and their role in decision-making

The process of decision-making is quite complex involving different aspects of logic, emotion, and intuition. The process of decision-making can be summarized as choosing the best alternative among a given plethora of options in order to achieve the desired outcome. This requires establishing numerous neural networks between various factors associated with the decision and creation of possible combinations and speculating their possible outcomes. In a nutshell, it is a highly coordinated process consuming the majority of the brain's energy. It has been found that the heart comprises an intrinsic neural system that contributes not only to the decision-making process but also the short-term and long-term memory. There are approximately 40,000 cells present in the heart known as sensory neurites which play a vital role in memory transfer. The heart is quite a mysterious organ, which functions as a blood-pumping machine and an endocrine gland, as well as possesses a nervous system. There are multiple factors that affect this heart ecosystem, and they directly affect our decision-making capabilities. These interlinked relationships hint toward the sensory neurites which modulate cognition and mood regulation. This review article aims to provide deeper insights into the various roles played by sensory neurites in decision-making and other cognitive functions. The article highlights the pivotal role of sensory neurites in the numerous brain functions, and it also meticulously discusses the mechanisms through which they modulate their effects.

Blood pressure pulsations modulate central neuronal activity via mechanosensitive ion channels

The transmission of the heartbeat through the cerebral vascular system causes intracranial pressure pulsations. We discovered that arterial pressure pulsations can directly modulate central neuronal activity. In a semi-intact rat brain preparation, vascular pressure pulsations elicited correlated local field oscillations in the olfactory bulb mitral cell layer. These oscillations did not require synaptic transmission but reflected baroreceptive transduction in mitral cells. This transduction was mediated by a fast excitatory mechanosensitive ion channel and modulated neuronal spiking activity. In awake animals, the heartbeat entrained the activity of a subset of olfactory bulb neurons within ~20 milliseconds. Thus, we propose that this fast, intrinsic interoceptive mechanism can modulate perception-for example, during arousal-within the olfactory bulb and possibly across various other brain areas.

Interactive effects of pain and arousal state on heart rate and cortical activity in the mouse anterior cingulate and somatosensory cortices

Sensory disconnection is a hallmark of sleep, yet the cortex retains some ability to process sensory information. Acute noxious stimulation during sleep increases the heart rate and the likelihood of awakening, indicating that certain mechanisms for pain sensing and processing remain active. However, processing of somatosensory information, including pain, during sleep remains underexplored. To assess somatosensation in natural sleep, we simultaneously recorded heart rate and local field potentials in the anterior cingulate (ACC) and somatosensory (S1) cortices of naïve, adult male mice, while applying noxious and non-noxious stimuli to their hind paws throughout their sleep-wake cycle. Noxious stimuli evoked stronger heart rate increases in both wake and non-rapid eye movement sleep (NREMS), and resulted in larger awakening probability in NREMS, as compared to non-noxious stimulation, suggesting differential processing of noxious and non-noxious information during sleep. Somatosensory information differentially reached S1 and ACC in sleep, eliciting complex transient and sustained responses in the delta, alpha, and gamma frequency bands as well as somatosensory evoked potentials. These dynamics depended on sleep state, the behavioral response to the stimulation and stimulation intensity (non-noxious vs. noxious). Furthermore, we found a correlation of the heart rate with the gamma band in S1 in the absence of a reaction in wake and sleep for noxious stimulation. These findings confirm that somatosensory information, including nociception, is sensed and processed during sleep even in the absence of a behavioral response.

Individual differences in seated resting heart rate are associated with multisensory perceptual function in older adults

There is evidence that cardiovascular function can influence sensory processing and cognition, which are known to change with age. However, whether the precision of unisensory and multisensory temporal perception is influenced by cardiovascular activity in older adults is uncertain. We examined whether seated resting heart rate (RHR) was associated with unimodal visual and auditory temporal discrimination as well as susceptibility to the audio-visual Sound Induced Flash Illusion (SIFI) in a large sample of older adults (N = 3232; mean age = 64.17 years, SD = 7.74, range = 50-93; 56% female) drawn from The Irish Longitudinal Study on Ageing (TILDA). Faster seated RHR was associated with better discretization of two flashes (but not two beeps) and increased SIFI susceptibility when the audio-visual stimuli were presented close together in time but not at longer audio-visual temporal offsets. Our findings suggest a significant relationship between cardiovascular activity and the precision of visual and audio-visual temporal perception in older adults, thereby providing novel evidence for a link between cardiovascular function and perceptual function in aging.

Multimodal acoustic-electric trigeminal nerve stimulation modulates conscious perception

Multimodal stimulation can reverse pathological neural activity and improve symptoms in neuropsychiatric diseases. Recent research shows that multimodal acoustic-electric trigeminal-nerve stimulation (TNS) (i.e., musical stimulation synchronized to electrical stimulation of the trigeminal nerve) can improve consciousness in patients with disorders of consciousness. However, the reliability and mechanism of this novel approach remain largely unknown. We explored the effects of multimodal acoustic-electric TNS in healthy human participants by assessing conscious perception before and after stimulation using behavioral and neural measures in tactile and auditory target-detection tasks. To explore the mechanisms underlying the putative effects of acoustic-electric stimulation, we fitted a biologically plausible neural network model to the neural data using dynamic causal modeling. We observed that (1) acoustic-electric stimulation improves conscious tactile perception without a concomitant change in auditory perception, (2) this improvement is caused by the interplay of the acoustic and electric stimulation rather than any of the unimodal stimulation alone, and (3) the effect of acoustic-electric stimulation on conscious perception correlates with inter-regional connection changes in a recurrent neural processing model. These results provide evidence that acoustic-electric TNS can promote conscious perception. Alterations in inter-regional cortical connections might be the mechanism by which acoustic-electric TNS achieves its consciousness benefits.

Heart Rate Variability during Online Video Game Playing in Habitual Gamers: Effects of Internet Addiction Scale, Ranking Score and Gaming Performance

Previous studies have demonstrated that individuals with internet gaming disorder (IGD) display abnormal autonomic activities at rest and during gameplay. Here, we examined whether and how in-game autonomic activity is modulated by human characteristics and behavioral performance of the player. We measured heart rate variability (HRV) in 42 male university student habitual gamers (HGs) when they played a round of League of Legends game online. Short-term HRV indices measured in early, middle and late phases of the game were compared between the players at high risk of developing IGD and those at low risk, as assessed by the revised Chen Internet addiction scale (CIAS-R). Multiple linear regression (MLR) was used to identify significant predictors of HRV measured over the whole gameplay period (WG), among CIAS-R, ranking score, hours of weekly playing and selected in-game performance parameters. The high-risk players showed a significantly higher low-frequency power/high-frequency power ratio (LF/HF) relative to the low-risk players, regardless of game phase. MLR analysis revealed that LF/HF measured in WG was predicted by, and only by, CIAS-R. The HRV indicators of sympathetic activity were found to be predicted only by the number of slain in WG (NSlain), and the indicators of parasympathetic activity were predicted by both CIAS-R and NSlain. Collectively, the results demonstrated that risk of developing IGD is associated with dysregulated autonomic balance during gameplay, and in-game autonomic activities are modulated by complex interactions among personal attributes and in-game behavioral performance of the player, as well as situational factors embedded in game mechanics.

Do we all synch alike? Brain-body-environment interactions in ASD

Autism Spectrum Disorder (ASD) is characterized by rigidity of routines and restricted interests, and atypical social communication and interaction. Recent evidence for altered synchronization of neuro-oscillatory brain activity with regularities in the environment and of altered peripheral nervous system function in ASD present promising novel directions for studying pathophysiology and its relationship to ASD clinical phenotype. Human cognition and action are significantly influenced by physiological rhythmic processes that are generated by both the central nervous system (CNS) and the autonomic nervous system (ANS). Normally, perception occurs in a dynamic context, where brain oscillations and autonomic signals synchronize with external events to optimally receive temporally predictable rhythmic information, leading to improved performance. The recent findings on the time-sensitive coupling between the brain and the periphery in effective perception and successful social interactions in typically developed highlight studying the interactions within the brain-body-environment triad as a critical direction in the study of ASD. Here we offer a novel perspective of autism as a case where the temporal dynamics of brain-body-environment coupling is impaired. We present evidence from the literature to support the idea that in autism the nervous system fails to operate in an adaptive manner to synchronize with temporally predictable events in the environment to optimize perception and behavior. This framework could potentially lead to novel biomarkers of hallmark deficits in ASD such as cognitive rigidity and altered social interaction.

Cardiac activity impacts cortical motor excitability

Human cognition and action can be influenced by internal bodily processes such as heartbeats. For instance, somatosensory perception is impaired both during the systolic phase of the cardiac cycle and when heartbeats evoke stronger cortical responses. Here, we test whether these cardiac effects originate from overall changes in cortical excitability. Cortical and corticospinal excitability were assessed using electroencephalographic and electromyographic responses to transcranial magnetic stimulation while concurrently monitoring cardiac activity with electrocardiography. Cortical and corticospinal excitability were found to be highest during systole and following stronger neural responses to heartbeats. Furthermore, in a motor task, hand-muscle activity and the associated desynchronization of sensorimotor oscillations were stronger during systole. These results suggest that systolic cardiac signals have a facilitatory effect on motor excitability-in contrast to sensory attenuation that was previously reported for somatosensory perception. Thus, it is possible that distinct time windows exist across the cardiac cycle, optimizing either perception or action.

Conscious processing of global and local auditory irregularities causes differentiated heartbeat-evoked responses

Recent research suggests that brain-heart interactions are associated with perceptual and self-consciousness. In this line, the neural responses to visceral inputs have been hypothesized to play a leading role in shaping our subjective experience. This study aims to investigate whether the contextual processing of auditory irregularities modulates both direct neuronal responses to the auditory stimuli (ERPs) and the neural responses to heartbeats, as measured with heartbeat-evoked responses (HERs). HERs were computed in patients with disorders of consciousness, diagnosed with a minimally conscious state or unresponsive wakefulness syndrome. We tested whether HERs reflect conscious auditory perception, which can potentially provide additional information for the consciousness diagnosis. EEG recordings were taken during the local-global paradigm, which evaluates the capacity of a patient to detect the appearance of auditory irregularities at local (short-term) and global (long-term) levels. The results show that local and global effects produce distinct ERPs and HERs, which can help distinguish between the minimally conscious state and unresponsive wakefulness syndrome patients. Furthermore, we found that ERP and HER responses were not correlated suggesting that independent neuronal mechanisms are behind them. These findings suggest that HER modulations in response to auditory irregularities, especially local irregularities, may be used as a novel neural marker of consciousness and may aid in the bedside diagnosis of disorders of consciousness with a more cost-effective option than neuroimaging methods.

Time-varying information measures: an adaptive estimation of information storage with application to brain-heart interactions

Network Physiology is a rapidly growing field of study that aims to understand how physiological systems interact to maintain health. Within the information theory framework the information storage (IS) allows to measure the regularity and predictability of a dynamic process under stationarity assumption. However, this assumption does not allow to track over time the transient pathways occurring in the dynamical activity of a physiological system. To address this limitation, we propose a time-varying approach based on the recursive least squares algorithm (RLS) for estimating IS at each time instant, in non-stationary conditions. We tested this approach in simulated time-varying dynamics and in the analysis of electroencephalographic (EEG) signals recorded from healthy volunteers and timed with the heartbeat to investigate brain-heart interactions. In simulations, we show that the proposed approach allows to track both abrupt and slow changes in the information stored in a physiological system. These changes are reflected in its evolution and variability over time. The analysis of brain-heart interactions reveals marked differences across the cardiac cycle phases of the variability of the time-varying IS. On the other hand, the average IS values exhibit a weak modulation over parieto-occiptal areas of the scalp. Our study highlights the importance of developing more advanced methods for measuring IS that account for non-stationarity in physiological systems. The proposed time-varying approach based on RLS represents a useful tool for identifying spatio-temporal dynamics within the neurocardiac system and can contribute to the understanding of brain-heart interactions.

Effect of subconscious changes in bodily response on thought shifting in people with accurate interoception

Our thought states shift from one state to another from moment to moment. The relationship between the thought shifting and bodily responses is yet to be directly examined. This exploratory study examined the influence of cardiovascular reactivity and interoception-sensing an internal bodily state-on the shifting of thought states. Participants (N = 100, 70 women) completed two tasks: the heartbeat counting task (HCT) and the vigilance task (VT). We assessed their interoceptive accuracy through their performance on the HCT. The VT was a simple sustained attention task in which participants pressed a key when the target stimulus appeared and were asked to report their thoughts. We presented subliminal vibration stimuli to induce alterations in heart rate (i.e., vibration block). Results showed that participants with higher interoceptive accuracy reported more continuation of self-referential thought (about past episodes and future plans regarding themselves) during the vibration block than did those with lower interoceptive accuracy. These results suggest that individuals with higher interoceptive accuracy are more likely to be influenced by their subliminal bodily response, resulting in divergent attention from the task and intermittent self-referential thought.

Removing the cardiac field artifact from the EEG using neural network regression

When EEG recordings are used to reveal interactions between central-nervous and cardiovascular processes, the cardiac field artifact (CFA) poses a major challenge. Because the electric field generated by cardiac activity is also captured by scalp electrodes, the CFA arises as a heavy contaminant whenever EEG data are analyzed time-locked to cardio-electric events. A typical example is measuring stimulus-evoked potentials elicited at different phases of the cardiac cycle. Here, we present a nonlinear regression method deploying neural networks that allows to remove the CFA from the EEG signal in such scenarios. We train neural network models to predict R-peak centered EEG episodes based on the ECG and additional CFA-related information. In a second step, these trained models are used to predict and consequently remove the CFA in EEG episodes containing visual stimulation occurring time-locked to the ECG. We show that removing these predictions from the signal effectively removes the CFA without affecting the intertrial phase coherence of stimulus-evoked activity. In addition, we provide the results of an extensive grid search suggesting a set of appropriate model hyperparameters. The proposed method offers a replicable way of removing the CFA on the single-trial level, without affecting stimulus-related variance occurring time-locked to cardiac events. Disentangling the cardiac field artifact (CFA) from the EEG signal is a major challenge when investigating the neurocognitive impact of cardioafferent traffic by means of the EEG. When stimuli are presented time-locked to the cardiac cycle, both sources of variance are systematically confounded. Here, we propose a regression-based approach deploying neural network models to remove the CFA from the EEG. This approach effectively removes the CFA on a single-trial level and is purely data-driven, providing replicable results.

Interoceptive rhythms in the brain

Sensing internal bodily signals, or interoception, is fundamental to maintain life. However, interoception should not be viewed as an isolated domain, as it interacts with exteroception, cognition and action to ensure the integrity of the organism. Focusing on cardiac, respiratory and gastric rhythms, we review evidence that interoception is anatomically and functionally intertwined with the processing of signals from the external environment. Interactions arise at all stages, from the peripheral transduction of interoceptive signals to sensory processing and cortical integration, in a network that extends beyond core interoceptive regions. Interoceptive rhythms contribute to functions ranging from perceptual detection up to sense of self, or conversely compete with external inputs. Renewed interest in interoception revives long-standing issues on how the brain integrates and coordinates information in distributed regions, by means of oscillatory synchrony, predictive coding or multisensory integration. Considering interoception and exteroception in the same framework paves the way for biological modes of information processing specific to living organisms.

Mind your heart to bear the weight: Cardiac interoception predicts action-related visual perception when wearing a heavy backpack

Visual perception can be modulated by the physiological potential for action. For instance, it was famously shown that a geographical slant appears steeper when wearing a heavy backpack than not wearing any. However, those results are not always replicated. In the present exploratory study, we test the hypothesis that the backpack weight's effect on perception relies on the ability of the cognitive system to integrate the physiological constraint's change rather than the change itself. Young adults (n = 54) wore an electrocardiogram monitor and completed a computerised task in which photographs of real geographical slants were displayed on a screen while wearing a heavy versus light backpack. The activity of the vagus nerve, as an index of physiological adaptability, was recorded as a proxy of the physiological state during the task. The participants also completed an interoception task assessing one's ability to detect his or her own heartbeat as the index of integration ability of the cognitive system. While Bayesian analyses revealed no difference in angle estimation between carrying a heavy versus light backpack, the results indicated that interoception predicted less accurate angle estimation only when wearing a heavy backpack. In contrast, there was anecdotal evidence that vagal activity changes predicted visual perception. Interoception might thus play a crucial role in the interplay between the physiological potential for action and action-related visual perception.

Reduced concentration performance and heartbeat-evoked potential in individuals with a history of a SARS-CoV-2 infection

The goal of characterizing long-term psychological and neural consequences of a SARS-CoV-2 infection has recently gained importance. Here, we examined the effect of a prior SARS-CoV-2 infection on neural markers of exteroceptive (P300) and interoceptive (heartbeat-evoked potential; HEP) signal processing, as well as on neuropsychological tests of attention, inhibition and episodic memory, in 23 adults with a self-reported history of SARS-CoV-2 infection versus 23 healthy controls. We found that the group with a prior infection showed decreased HEP (but not P300) amplitudes, as well as reduced attention/concentration performance. These results suggest that SARS-CoV-2 may damage neural structures of cardiac interoception, thereby potentially contributing to cognitive and psychological long-term deficits. Modulations of interoceptive processing after a SARS-CoV-2 infection are thus a promising target for future research.

Modulation of the heartbeat evoked cortical potential by hypnotizability and hypnosis

Hypnotizability is a psychophysiological trait measured by scales and associated with several differences, including interoceptive accuracy and the morpho-functional characteristics of interoception-related brain regions. The aim of the study was to assess whether the amplitude of the heartbeat evoked cortical potential (HEP), a correlate of interoceptive accuracy, differs in participants with low (lows) and high (highs) hypnotizability scores (assessed by the Stanford Hypnotic Susceptibility Scale, Form A) before and after the induction of hypnosis. ECG and EEG were monitored in 16 highs and 15 lows during an experimental session, including open eyes baseline (B), closed eyes relaxation (R), hypnotic induction (IND), neutral hypnosis (NH), and post session baseline (Post). No significant difference was observed between groups and conditions in autonomic variables. The HEP amplitude was lower in highs than in lows at the right parietal site, likely due to hypnotizability related differences in the functional connection between the right insula and parietal cortex. It increased in highs and decreased in lows across the session, possibly due to the highs' preeminently internally directed attention and to the lows' possible disengagement from the task. Since interoception is involved in several cognitive-emotional functions, its hypnotizability related differences may contribute to the variability of experience and behavior in daily life.

The impact of cardiac phases on multisensory integration

The brain continuously processes information coming from both the external environment and visceral signals generated by the body. This constant information exchange between the body and the brain allows signals originating from the oscillatory activity of the heart, among others, to influence perception. Here, we investigated how the cardiac phase modulates multisensory integration, which is the process that allows information from multiple senses to combine non-linearly to reduce environmental uncertainty. Forty healthy participants completed a Simple Detection Task with unimodal (Auditory, Visual, Tactile) and bimodal (Audio-Tactile, Audio-Visual, Visuo-Tactile) stimuli presented 250 ms and 500 ms after the R-peak of the electrocardiogram, that is, systole and diastole, respectively. First, we found a nonspecific effect of the cardiac cycle phases on detection of both unimodal and bimodal stimuli. Reaction times were faster for stimuli presented during diastole, compared to systole. Then, applying the Race Model Inequality approach to quantify multisensory integration, Audio-Tactile and Visuo-Tactile, but not Audio-Visual stimuli, showed higher integration when presented during diastole than during systole. These findings indicate that the impact of the cardiac phase on multisensory integration may be specific for stimuli including somatosensory (i.e., tactile) inputs. This suggests that the heartbeat-related noise, which according to the interoceptive predictive coding theory suppresses somatosensory inputs, also affects multisensory integration during systole. In conclusion, our data extend the interoceptive predictive coding theory to the multisensory domain. From a more mechanistic view, they may reflect a reduced optimization of neural oscillations orchestrating multisensory integration during systole.

Breathing in waves: Understanding respiratory-brain coupling as a gradient of predictive oscillations

Breathing plays a crucial role in shaping perceptual and cognitive processes by regulating the strength and synchronisation of neural oscillations. Numerous studies have demonstrated that respiratory rhythms govern a wide range of behavioural effects across cognitive, affective, and perceptual domains. Additionally, respiratory-modulated brain oscillations have been observed in various mammalian models and across diverse frequency spectra. However, a comprehensive framework to elucidate these disparate phenomena remains elusive. In this review, we synthesise existing findings to propose a neural gradient of respiratory-modulated brain oscillations and examine recent computational models of neural oscillations to map this gradient onto a hierarchical cascade of precision-weighted prediction errors. By deciphering the computational mechanisms underlying respiratory control of these processes, we can potentially uncover new pathways for understanding the link between respiratory-brain coupling and psychiatric disorders.

Modulation of heartbeat-evoked potential and cardiac cycle effect by auditory stimuli

Interoception has been proposed as a factor that influences various psychological processes (Khalsa et al., 2018). Afferent signals from the cardiovascular system vary across cardiac cycle phases. Heartbeat-evoked potentials (HEP) and event-related potentials (ERP) were measured to examine whether interoceptive signals differed between cardiac cycle phases. Simultaneously, participants performed an auditory oddball task in which the timing of the presenting stimulus was synchronized with the heartbeat. Pure tones were presented at 10 ms (late diastole condition), 200 ms (systole condition), or 500 ms after the R wave (diastole condition). Greater HEP amplitudes were observed when the tone was presented during diastole than during systole or late diastole. ERP showed the same tendency: a greater amplitude was observed during diastole than systole or late diastole. These results suggest that the processing of interoception reflected by HEP and exteroception reflected by ERP share attentional resources when both stimuli coincide. When the tone was presented during systole, attention to the internal state decreased compared with when the tone was presented during diastole, and attention was distributed to both exteroception and interoception. Our study suggests that HEP may be considered an indication of a relative amount of resources to process the interoception.

Multidimensional assessment of heartbeat-evoked responses in disorders of consciousness

Because consciousness does not necessarily translate into overt behaviour, detecting residual consciousness in noncommunicating patients remains a challenge. Bedside diagnostic methods based on EEG are promising and cost-effective alternatives to detect residual consciousness. Recent evidence showed that the cortical activations triggered by each heartbeat, namely, heartbeat-evoked responses (HERs), can detect through machine learning the presence of minimal consciousness and distinguish between overt and covert minimal consciousness. In this study, we explore different markers to characterize HERs to investigate whether different dimensions of the neural responses to heartbeats provide complementary information that is not typically found under standard event-related potential analyses. We evaluated HERs and EEG average non-locked to heartbeats in six types of participants: healthy state, locked-in syndrome, minimally conscious state, vegetative state/unresponsive wakefulness syndrome, comatose and brain-dead patients. We computed a series of markers from HERs that can generally separate the unconscious from the conscious. Our findings indicate that HER variance and HER frontal segregation tend to be higher in the presence of consciousness. These indices, when combined with heart rate variability, have the potential to enhance the differentiation between different levels of awareness. We propose that a multidimensional evaluation of brain-heart interactions could be included in a battery of tests to characterize disorders of consciousness. Our results may motivate further exploration of markers in brain-heart communication for the detection of consciousness at the bedside. The development of diagnostic methods based on brain-heart interactions may be translated into more feasible methods for clinical practice.

In natura heart rate variability predicts subsequent alcohol use in individuals in early recovery from alcohol use disorder

Impairment in autonomic self-regulatory functioning reflected by reduced heart rate variability (HRV) is a common feature of alcohol use disorder (AUD) and is believed to heighten AUD relapse risk. However, to date, no study has explored associations between in natura HRV and subsequent alcohol use among individuals seeking AUD recovery. In this study, 42 adults in the first year of a current AUD recovery attempt were monitored for 4 days using ambulatory electrocardiogram, followed by 90 days of alcohol use monitoring using timeline follow-back. HRV indices (independent variables) reflecting autonomic neurocardiac engagement were calculated from electrocardiogram recordings. Alcohol use (dependent variable) was calculated from timeline follow-back and expressed as per cent days abstinent (PDA). The sample was 73.81% White/European American, 19.05% Black/African American, 4.76% Asian, and 2.38% Other race/Mixed race. As predicted, higher parasympathetically mediated HRV and lower heart rate were associated with greater PDA over 90-day follow-up. Additionally, interactions between these measures and baseline PDA indicated higher parasympathetically mediated HRV and lower heart rate mitigated the deleterious positive association between baseline and follow-up alcohol use. Including factors known to influence alcohol use and/or HRV in the models did not meaningfully alter their results. Findings are consistent with psychophysiological theories implicating autonomic self-regulatory functioning in AUD treatment outcomes and suggest that select HRV indices may have utility as indicants of risk for alcohol use lapse in individuals in early AUD recovery. Findings provide theoretical support for HRV Biofeedback for this population, which exercises the psychophysiological systems that support self-regulation.

Temporospatial Nestedness in Consciousness: An Updated Perspective on the Temporospatial Theory of Consciousness

Time and space are fundamental elements that permeate the fabric of nature, and their significance in relation to neural activity and consciousness remains a compelling yet unexplored area of research. The Temporospatial Theory of Consciousness (TTC) provides a framework that links time, space, neural activity, and consciousness, shedding light on the intricate relationships among these dimensions. In this review, I revisit the fundamental concepts and mechanisms proposed by the TTC, with a particular focus on the central concept of temporospatial nestedness. I propose an extension of temporospatial nestedness by incorporating the nested relationship between the temporal circuit and functional geometry of the brain. To further unravel the complexities of temporospatial nestedness, future research directions should emphasize the characterization of functional geometry and the temporal circuit across multiple spatial and temporal scales. Investigating the links between these scales will yield a more comprehensive understanding of how spatial organization and temporal dynamics contribute to conscious states. This integrative approach holds the potential to uncover novel insights into the neural basis of consciousness and reshape our understanding of the world-brain dynamic.

Heart Rate Variability Code: Does It Exist and Can We Hack It?

A code is generally defined as a system of signals or symbols for communication. Experimental evidence is synthesized for the presence and utility of such communication in heart rate variability (HRV) with particular attention to fetal HRV: HRV contains signatures of information flow between the organs and of response to physiological or pathophysiological stimuli as signatures of states (or syndromes). HRV exhibits features of time structure, phase space structure, specificity with respect to (organ) target and pathophysiological syndromes, and universality with respect to species independence. Together, these features form a spatiotemporal structure, a phase space, that can be conceived of as a manifold of a yet-to-be-fully understood dynamic complexity. The objective of this article is to synthesize physiological evidence supporting the existence of HRV code: hereby, the process-specific subsets of HRV measures indirectly map the phase space traversal reflecting the specific information contained in the code required for the body to regulate the physiological responses to those processes. The following physiological examples of HRV code are reviewed, which are reflected in specific changes to HRV properties across the signal-analytical domains and across physiological states and conditions: the fetal systemic inflammatory response, organ-specific inflammatory responses (brain and gut), chronic hypoxia and intrinsic (heart) HRV (iHRV), allostatic load (physiological stress due to surgery), and vagotomy (bilateral cervical denervation). Future studies are proposed to test these observations in more depth, and the author refers the interested reader to the referenced publications for a detailed study of the HRV measures involved. While being exemplified mostly in the studies of fetal HRV, the presented framework promises more specific fetal, postnatal, and adult HRV biomarkers of health and disease, which can be obtained non-invasively and continuously.

The Current of Consciousness: Neural Correlates and Clinical Aspects

PURPOSE OF REVIEW

In this review, we summarize the current understanding of consciousness including its neuroanatomic basis. We discuss major theories of consciousness, physical exam-based and electroencephalographic metrics used to stratify levels of consciousness, and tools used to shed light on the neural correlates of the conscious experience. Lastly, we review an expanded category of 'disorders of consciousness,' which includes disorders that impact either the level or experience of consciousness.

RECENT FINDINGS

Recent studies have revealed many of the requisite EEG, ERP, and fMRI signals to predict aspects of the conscious experience. Neurological disorders that disrupt the reticular activating system can affect the level of consciousness, whereas cortical disorders from seizures and migraines to strokes and dementia may disrupt phenomenal consciousness. The recently introduced memory theory of consciousness provides a new explanation of phenomenal consciousness that may explain better than prior theories both experimental studies and the neurologist's clinical experience. Although the complete neurobiological basis of consciousness remains a mystery, recent advances have improved our understanding of the physiology underlying level of consciousness and phenomenal consciousness.

Interoception: Probing internal state is inherent to perception and cognition

Interoception, i.e. the perception of the organism physiological state, jointly operates with perception and cognition, including when homeostatic balance is not particularly challenged. Studying interoception offers new leads to understanding the link between internal state, neural activity, and behavior.

Complex Brain-Heart Mapping in Mental and Physical Stress

OBJECTIVE

The central and autonomic nervous systems are deemed complex dynamic systems, wherein each system as a whole shows features that the individual system sub-components do not. They also continuously interact to maintain body homeostasis and appropriate react to endogenous and exogenous stimuli. Such interactions are comprehensively referred to functional brain-heart interplay (BHI). Nevertheless, it remains uncertain whether this interaction also exhibits complex characteristics, that is, whether the dynamics of the entire nervous system inherently demonstrate complex behavior, or if such complexity is solely a trait of the central and autonomic systems. Here, we performed complexity mapping of the BHI dynamics under mental and physical stress conditions.

METHODS AND PROCEDURES

Electroencephalographic and heart rate variability series were obtained from 56 healthy individuals performing mental arithmetic or cold-pressure tasks, and physiological series were properly combined to derive directional BHI series, whose complexity was quantified through fuzzy entropy.

RESULTS

The experimental results showed that BHI complexity is mainly modulated in the efferent functional direction from the brain to the heart, and mainly targets vagal oscillations during mental stress and sympathovagal oscillations during physical stress.

CONCLUSION

We conclude that the complexity of BHI mapping may provide insightful information on the dynamics of both central and autonomic activity, as well as on their continuous interaction.

CLINICAL IMPACT

This research enhances our comprehension of the reciprocal interactions between central and autonomic systems, potentially paving the way for more accurate diagnoses and targeted treatments of cardiovascular, neurological, and psychiatric disorders.

Reward responsiveness in autism and autistic traits - Evidence from neuronal, autonomic, and behavioural levels

Autism has been linked to atypicalities in reward processing, especially in the social domain. However, results are heterogeneous, and their interpretation is hindered by the use of personally non-relevant social rewards. In this study we investigated behavioural (reaction times), neuronal (event-related potentials), and autonomic (pupil sizes) responses to personally relevant social rewards, money, and neutral outcomes in 26 autistic and 53 non-autistic subjects varying in levels of autistic traits. As hypothesised and preregistered, autism and autistic traits did not differently influence responses to social, monetary, or neutral outcomes on either response level. While groups did not differ in behaviour (reaction times), autism was linked to generally enhanced brain responses in early anticipation and larger pupil constrictions in reward reception. Together, these results suggest that when using personally relevant stimuli, autism is linked to generally preserved, although less neuronally efficient processing of rewards. Considering the role of social relevance in reward processing, we propose an interpretation of contradictory evidence from clinical practice and empirical research.

Brain State Relays Self-Processing and Heartbeat-Evoked Cortical Responses

The self has been proposed to be grounded in interoceptive processing, with heartbeat-evoked cortical activity as a neurophysiological marker of this processing. However, inconsistent findings have been reported on the relationship between heartbeat-evoked cortical responses and self-processing (including exteroceptive- and mental-self-processing). In this review, we examine previous research on the association between self-processing and heartbeat-evoked cortical responses and highlight the divergent temporal-spatial characteristics and brain regions involved. We propose that the brain state relays the interaction between self-processing and heartbeat-evoked cortical responses and thus accounts for the inconsistency. The brain state, spontaneous brain activity which highly and continuously changes in a nonrandom way, serves as the foundation upon which the brain functions and was proposed as a point in an extremely high-dimensional space. To elucidate our assumption, we provide reviews on the interactions between dimensions of brain state with both self-processing and heartbeat-evoked cortical responses. These interactions suggest the relay of self-processing and heartbeat-evoked cortical responses by brain state. Finally, we discuss possible approaches to investigate whether and how the brain state impacts the self-heart interaction.

Association between the acceleration of access to visual awareness of grating orientation with higher heart rate at high-altitude

Many studies have indicated a strong relationship between cardiac and brain activities, both of which are sensitive to high-altitude exposure. This study combined a consciousness access task and electrocardiograms (ECG) to uncover conscious awareness in response to high-altitude exposure and its relation to cardiac activity. When compared with the low-altitude groups, the behavioral results showed that the high-altitude participants shortened the time of access to visual awareness of grating orientation, which was accompanied by a faster heart rate, excluding the influence of pre-stimulus heart rate, extent of cardiac deceleration after presenting the stimulus, and task difficulty. Although there were post-stimulation cardiac deceleration and post-response acceleration at both high and low altitudes, a slight increase in heart rate after stimulation at high altitudes may indicate that participants at high altitudes could quickly readjust their attention to the target stimulus. More importantly, the drift diffusion model (DDM) was used to fit the access time distribution of all participants. These results suggest that shorter time at high altitudes might be due to the lower threshold, suggesting that less evidence in high-altitude participants was required to access visual consciousness. The participants' heart rates also negatively predicted the threshold through a hierarchical drift diffusion modeling (HDDM) regression. These findings imply that individuals with higher heart rates at high altitudes have a greater cognitive burden.

Associations between mental health, blood pressure and the development of hypertension

Multiple studies have reported a link between mental health and high blood pressure with mixed or even contradictory findings. Here, we resolve those contradictions and further dissect the cross-sectional and longitudinal relationship between mental health, systolic blood pressure, and hypertension using extensive psychological, medical and neuroimaging data from the UK Biobank. We show that higher systolic blood pressure is associated with fewer depressive symptoms, greater well-being, and lower emotion-related brain activity. Interestingly, impending hypertension is associated with poorer mental health years before HTN is diagnosed. In addition, a stronger baseline association between systolic blood pressure and better mental health was observed in individuals who develop hypertension until follow-up. Overall, our findings offer insights on the complex relationship between mental health, blood pressure, and hypertension, suggesting that-via baroreceptor mechanisms and reinforcement learning-the association of higher blood pressure with better mental health may ultimately contribute to the development of hypertension.

Enhanced external counterpulsation modulates the heartbeat evoked potential

Introduction: Accumulating evidence suggests that enhanced external counterpulsation (EECP) influences cardiac functions, hemodynamic characteristics and cerebral blood flow. However, little is known about whether or how the EECP affects the brain-heart coupling to produce these physiological and functional changes. We aimed to determine if the brain-heart coupling is altered during or after EECP intervention by assessing the heartbeat evoked potential (HEP) in healthy adults.

Methods: Based on a random sham-controlled design, simultaneous electroencephalography and electrocardiography signals as well as blood pressure and flow status data were recorded before, during and after two consecutive 30-min EECP in 40 healthy adults (female/male: 17/23; age: 23.1 ± 2.3 years). HEP amplitude, frequency domain heart rate variability, electroencephalographic power and hemodynamic measurements of 21 subjects (female/male: 10/11; age: 22.7 ± 2.1 years) receiving active EECP were calculated and compared with those of 19 sham control subjects (female/male: 7/12; age: 23.6 ± 2.5 years).

Results: EECP intervention caused immediate obvious fluctuations of HEP from 100 to 400 ms after T-peak and increased HEP amplitudes in the (155–169) ms, (354–389) ms and (367–387) ms time windows after T-peak in the region of the frontal pole lobe. The modifications in HEP amplitude were not associated with changes in the analyzed significant physiological measurements and hemodynamic variables.

Discussion: Our study provides evidence that the HEP is modulated by immediate EECP stimuli. We speculate that the increased HEP induced by EECP may be a marker of enhanced brain-heart coupling. HEP may serve as a candidate biomarker for the effects and responsiveness to EECP.

Perceived time expands and contracts within each heartbeat

Perception of passing time can be distorted.¹ Emotional experiences, particularly arousal, can contract or expand experienced duration via their interactions with attentional and sensory processing mechanisms.^2,3 Current models suggest that perceived duration can be encoded from accumulation processes^4,5 and from temporally evolving neural dynamics.^6,7 Yet all neural dynamics and information processing ensue at the backdrop of continuous interoceptive signals originating from within the body. Indeed, phasic fluctuations within the cardiac cycle impact neural and information processing.^{8,9,10,11,12,13,14,15} Here, we show that these momentary cardiac fluctuations distort experienced time and that their effect interacts with subjectively experienced arousal. In a temporal bisection task, durations (200-400 ms) of an emotionally neutral visual shape or auditory tone (experiment 1) or of an image displaying happy or fearful facial expressions (experiment 2) were categorized as short or long.¹⁶ Across both experiments, stimulus presentation was time-locked to systole, when the heart contracts and baroreceptors fire signals to the brain, and to diastole, when the heart relaxes, and baroreceptors are quiescent. When participants judged the duration of emotionally neural stimuli (experiment 1), systole led to temporal contraction, whereas diastole led to temporal expansion. Such cardiac-led distortions were further modulated by the arousal ratings of the perceived facial expressions (experiment 2). At low arousal, systole contracted while diastole expanded time, but as arousal increased, this cardiac-led time distortion disappeared, shifting duration perception toward contraction. Thus, experienced time contracts and expands within each heartbeat-a balance that is disrupted under heightened arousal.

Central control of cardiac activity as assessed by intra-cerebral recordings and stimulations

Some of the most important integrative control centers for the autonomic nervous system are located in the brainstem and the hypothalamus. However, growing recent neuroimaging evidence support that a set of cortical regions, named the central autonomic network (CAN), is involved in autonomic control and seems to play a major role in continuous autonomic cardiac adjustments to high-level emotional, cognitive or sensorimotor cortical activities. Intracranial explorations during stereo-electroencephalography (SEEG) offer a unique opportunity to address the question of the brain regions involved in heart-brain interaction, by studying: (i) direct cardiac effects produced by the electrical stimulation of specific brain areas; (ii) epileptic seizures inducing cardiac modifications; (iii) cortical regions involved in cardiac interoception and source of cardiac evoked potentials. In this review, we detail the available data assessing cardiac central autonomic regulation using SEEG, address the strengths and also the limitations of this technique in this context, and discuss perspectives. The main cortical regions that emerge from SEEG studies as being involved in cardiac autonomic control are the insula and regions belonging to the limbic system: the amygdala, the hippocampus, and the anterior and mid-cingulate. Although many questions remain, SEEG studies have already demonstrated afferent and efferent interactions between the CAN and the heart. Future studies in SEEG should integrate these afferent and efferent dimensions as well as their interaction with other cortical networks to better understand the functional heart-brain interaction.