Neural correlates of heart-focused interoception: a functional magnetic resonance imaging meta-analysis

Abstract

Interoception is the ability to perceive one's internal body state including visceral sensations. Heart-focused interoception has received particular attention, in part due to a readily available task for behavioural assessment, but also due to accumulating evidence for a significant role in emotional experience, decision-making and clinical disorders such as anxiety and depression. Improved understanding of the underlying neural correlates is important to promote development of anatomical-functional models and suitable intervention strategies. In the present meta-analysis, nine studies reporting neural activity associated with interoceptive attentiveness (i.e. focused attention to a particular interoceptive signal for a given time interval) to one's heartbeat were submitted to a multilevel kernel density analysis. The findings corroborated an extended network associated with heart-focused interoceptive attentiveness including the posterior right and left insula, right claustrum, precentral gyrus and medial frontal gyrus. Right-hemispheric dominance emphasizes non-verbal information processing with the posterior insula presumably serving as the major gateway for cardioception. Prefrontal neural activity may reflect both top-down attention deployment and processing of feed-forward cardioceptive information, possibly orchestrated via the claustrum.This article is part of the themed issue 'Interoception beyond homeostasis: affect, cognition and mental health'.

Keywords: brain activity; cardioception; functional magnetic resonance imaging; heartbeat detection task; interoception; meta-analysis.

Figure 1.

Flow diagram according to PRISMA guidelines [46] depicting the flow of information through the different phases of the literature search for the current meta-analysis. See the text for details regarding reasons for inclusions and exclusions. (Online version in colour.)

Figure 2.

Results of MKDA meta-analysis for neural activity associated with cardioceptive attentiveness (I, axial; II, coronal; III, sagittal view). Slices at 18 mm distance were superimposed on the standard SPM8 high resolution anatomical image SPM8_colin27T1_seg.img and show all identified brain areas representatively. Yellow voxels indicate activation meeting the ‘height-based’ threshold (p < 0.05, whole-brain family-wise error (FWER) corrected). Incremental activation outside the 10 mm kernel region (FWER-corrected for spatial extent at p < 0.05) is shown in magenta and turquoise with primary alpha levels at p < 0.01 and p < 0.05, respectively (FWER-corrected, one-tailed). Coordinates mark cluster peaks in MNI space. I, inferior; S, superior; P, posterior, A, anterior; L, left; R, right.