Multicentric evidence of emotional impairments in hypertensive heart disease

Abstract

The mechanisms underlying emotional alterations constitute a key research target in neuroscience. Emerging evidence indicates that these disruptions can be related to abnormal interoception (i.e., the sensing of visceral feelings), as observed in patients with cardiodynamic deficits. To directly assess these links, we performed the first multicenter study on emotion recognition and interoception in patients with hypertensive heart disease (HHD). Participants from two countries completed a facial emotion recognition test, and a subsample additionally underwent an interoception protocol based on a validated heartbeat detection task. HHD patients from both countries presented deficits in the recognition of overall and negative emotions. Moreover, interoceptive performance was impaired in the HHD group. In addition, a significant association between interoceptive performance and emotion recognition was observed in the control group, but this relation was abolished in the HHD group. All results survived after covariance with cognitive status measures, suggesting they were not biased by general cognitive deficits in the patients. Taken together, these findings suggest that emotional recognition alterations could represent a sui generis deficit in HHD, and that it may be partially explained by the disruption of mechanisms subserving the integration of neuro-visceral signals.

Figure 1

Facial emotion recognition results. (A) Multicenter results comparing patients and controls. Blue boxes represent controls and red boxes refer to HHD patients. The middle line in each box indicates mean. Whiskers indicate SD. Solid dots indicate each subject’s performance. Asterisks (*) indicate significant differences (p < 0.05) after analyses of covariance. (B) Single-country results. Violet boxes represent controls and pink boxes refer to HHD patients. The middle line in each box indicates mean. Whiskers indicate SD. Asterisks (*) indicate significant differences (p < 0.05) after analyses of covariance.

Figure 2

Associations between facial emotion recognition and interoceptive performance in Country-2. (A) (Top) Schematic representation of the heartbeat detection task. In the interoceptive condition, participants were asked to pay attention to their own heartbeats and tap a key in synchrony with them. (Bottom) Boxplot representation of interoceptive performance. The dots capture each subject’s performance; the horizontal lines inside the box represent the mean; the asterisks indicate statistical differences between groups (p = 0.05). (B) Scatterplots of Pearson’s correlations between interoceptive and emotion recognition outcomes for controls and HHD patients (Country-2). The Y axis represents interoceptive performance in interoceptive condition for each participant. The X axis represents the subjects’ mean score for overall facial emotion recognition.