Neuruppin, 8 August 2023

There is nothing new about the idea of close connections between heart and brain. The Integrated Working Group (IAG) Heart & Brain brings disciplines from cardiology, psychology and neurology together. It presented its activities in a separate session at the recent symposium of the research domain “Cardiovascular Disease”.

Prof. Dr. Anja Haase-Fielitz and PD Dr. Kerstin Jost as speakers of the IAG gave insights into the manifold interactions between heart and mind. They quoted the Broken Heart syndrome as an example, where extreme emotional stress may result in sudden functional loss of the heart with symptoms resembling a heart attack. The link between heart and brain also plays a major role in other pathologies, such as the Stroke Heart syndrome – cardiac events like dysrhythmia after severe ischemic stroke. It is interesting to note that persons with mental disorders have a 50 % increased risk of developing additional cardiovascular problems, an even higher risk compared to patients suffering from obesity or diabetes. The IAG is actively involved in numerous studies, some of which were presented during the session:

Pupil as marker for balance between vagus and sympathetic nerve

PURE: Dr. Susanne Fichtner and Alexander Kleinau presented preliminary findings from the PURE study. They are currently recruiting patients with acute decompensated heart failure at the Bernau heart clinic and analyze their pupil reactions at rest and under cognitive stress respectively. The interaction between vagus and sympathetic nerve is disturbed in acute heart failure. Pupil size is a marker for the balance between vagus and sympathetic nerve. The study aims to test the suitability of pupil parameters for predicting the course of heart failure, for example the development of strokes, heart attacks, or mortality. The proportion of targeted test subjects integrated to date is 70 per cent.  

Impact of depression on physical symptoms increases with age.

DEPRES: Josephine Hoffmann (Herzzentrum Bernau) and Yasmin Dalati (psychiatry ward / Rüdersdorf) reported on the DEPRES study in which patients with atrial fibrillation are examined for depressive symptoms. The impact of depression on physical symptoms increases with age, and less so on the mood. Apart from suicides, the shortening of the lifespan – ten years on average – is primarily due to cardiovascular disorders. A total of 100 mainly elderly patients with atrial fibrillation from the heart clinic Brandenburg and others from the university outpatient department Bernau were interviewed about mood, quality of sleep, appetite and negative thoughts, to evaluate the level of depressive symptoms. First results suggest that clinically relevant indications of depression were found via external assessment in about 50 % of all patients, whereas only one in five had been known to be depressive before. Many of the interviewees said they would appreciate professional help.      
One third of test subjects were even open to a digital solution, i.e. a Smartphone App, despite their advanced age.  The two researchers are applying to the MHB for funding for a follow-up study named APRES; they plan to evaluate the use of an App in the treatment of comorbid depression in patients with atrial fibrillation.

Eyetracking serves to identify experts

DECODE: Dr. Jochen Laubrock, formerly visiting professor of general psychology at the MHB, now University of Potsdam, presented the DECODE study he conducted during a scientific internship together with Alexander Krutz and Prof. Sebastian Spethmann; findings were published in the "Journal of Medical Imaging". Eye movements of 15 MHB students while evaluating echocardiography images were tracked and compared to those of 15 experienced diagnosticians. The good news is that correct diagnoses were actually far more frequent among the experts. In addition, eyetracking revealed that the gaze of experts went faster and for longer to the region of diagnostic relevance – the left ventricular ejection fraction. Students were easily distracted by movements of the mitral valve. Visual behavior alone was enough to distinguish experts from novices. An interesting question emerged during discussion: can simple instructions on how to control eye movements help students to improve their diagnostic skills? Follow-up measurements among the student test subjects are in the planning stage.  

How patients view digital aids

DIPAH: On behalf of a large number of colleagues involved, Dunja Bruch, M.Sc. (Herzzentrum Bernau and psychiatry department Rüdersdorf) presented the mixed-methods study DIPAH which received financial support from the Federal Government’s innovation fund. Her colleague Dr. Eileen Wengemuth conducted extensive interviews among patients with hypertension about current therapies and their views on digital aids. Test persons mentioned helpful factors to take preventive measures, such as better motivation after the diagnosis of heart disease, and social support, for example from individuals who are persistently demanding the patient should do something. Hindering factors can be family pressures which leave no time to look after one’s own health. Data privacy was one of the reasons given not to use Apps. Other test subjects had no objections to digital aids, feeling that today “we are all open books anyway”. Users of a hypertension App were also interviewed. One mitigating factor they mentioned is that the reaction of doctors to patients’ systematic recording of blood pressure levels is not particularly positive. Digital aids are primarily used by educated patients; it is therefore important to ensure that digital aids will not leave less educated people even further behind.
       
For more information on the IAG Heart & Brain see here.