Neuro- and psycho-cardiology are young interdisciplinary fields, which have experienced a spike of scientific interest in recent years not least of all due to their formerly underestimated high clinical relevance. Our research group focuses on the effects of neurogenic or psychogenic stress on the heart as well as on the impact of cardiac disease on behavior and mental health. This includes Takotsubo syndrome, stroke heart syndrome, or heart failure (HF) with comorbid depression. 

Takotsubo syndrome (TTS) or 'broken-heart' syndrome is an acute HF syndrome that is accompanied by the symptoms of acute myocardial infarction (AMI) and is usually preceded by severe emotional or physical stress (e. g. a stroke as part of the stroke-heart syndrome (SHS) complex). TTS usually affects postmenopausal women (90%). Men are affected more seldom, but suffer from a markedly impaired acute and long-term prognosis. Interestingly, patients with TTS are also more likely to suffer from psychiatric or neurological conditions. Since systolic cardiac function recovers in most cases of TTS, it has been historically regarded as a benign disease entity. However, recent clinical studies reveal a markedly limited acute and long-term prognosis comparable to AMI. Since increased catecholamine levels can be detected in TTS compared to e. g. in AMI, or in other acute neurocardiogenic syndromes, it is assumed that a neurogenic stress-induced catecholamine storm plays a central role in the pathogenesis. In addition, myocardial and systemic inflammation can be observed in animal models of TTS as well as in patients, suggesting catecholamine-induced myocardial inflammation as a contributing factor. Unfortunately, there is no specific therapy for acute neurocardiogenic syndromes like TTS or SHS so far, despite their severe impact on patient prognosis.

Heart failure (HF) is the leading cause of death in Europe, while depression (DEP) is the leading cause of disability worldwide. The prevalence of DEP in HF is much higher than in the general population. Conversely, patients with symptoms of DEP have an increased risk of HF. Unfortunately, HF patients with comorbid DEP have an increased hospitalization rate and mortality. The guidelines of the European Society of Cardiology recommend that antidepressant pharmacotherapy be explicitly avoided for HF patients, who are often severely affected, due to a lack of antidepressant efficacy with an additional increase in mortality by these medications. Interestingly, both HF and DEP have been associated with neuro-immune interactions, suggesting an overlapping pathophysiology. In this regard, the neuroimmune network hypothesis assumes that psychological stress triggers priming of cortico-amygdala circuits, which in turn intensifies the stress responses and may thus contribute to increased myocardial and/or systemic inflammation. Therefore, stress-induced catecholamine release may also play a role here. Due to the lack of a specific pharmacologic therapy of DEP in HF patients, there is an urgent clinical need for novel therapeutic approaches.

Our mission is to explore the connection between neuro-psychological disturbance and cardiovascular health. By combining experimental models with clinical approaches, we strive to translate novel insights and therapeutic strategies into clinical applications. For this, we employ a multidisciplinary approach that integrates molecular and biochemical methods, animal and cellular models with advanced laboratory techniques to replicate and study neuro-psycho-cardiological conditions. We conduct clinical studies to validate our experimental findings and assess their applicability in real-world scenarios. With regard to catecholamine-driven myocardial inflammation in TTS, we observed a significant benefit of immune-modulation in experimental pre-clinical models. We are currently investigating the potential benefit of this therapeutic strategy in acute high-risk TTS patients in a randomized double-blind multicentre trial (Cyclosporine In Takotsubo syndrome (CIT) trial, CIT-DZHK29, NCT05946772) lead by Professor Norbert Frey and Bastian Bruns from the Department of Cardiology, Angiology and Pneumology at Heidelberg University Hospital (Figure to the right, from Bruns et al.¹).

 

Key publications:

• ¹Bruns B, Elsous N, Burghaus I, Steyrer K, Joos M, Krämer T, Scheffel M, Blankenberg S, Eitel I, Massberg S, Thiele H, Meder B, Backs J, Frey N. Rationale and design of the cyclosporine in Takotsubo syndrome (CIT) trial. Am Heart J. 2025 Nov:289:147-157.
• Bruns B, Antoniou M, Baier I, Joos M, Sevinchan M, Moog MC, Dieterich C, Friederich HC, Khan H, Wilson H, Herzog W, Dawson D, Frey N, Schultz JH, Backs J. Calcineurin signaling promotes Takotsubo syndrome. Nat Cardiovasc Res. 2023 Jul;2(7):645-655.
• Bruns B, Joos M, Elsous N, Katus HA, Schultz JH, Frey N, Backs J, Meder B. Insulin resistance in Takotsubo syndrome. ESC Heart Fail. 2024 Jun;11(3):1515-1524.
• Joos M, Backs J, Frey N, Bruns B. The role of insulin and glucose handling in takotsubo syndrome. Interv. Cardiol. (2024) 16,1:796-79.
• Gronewold N, Schunn F, Ihrig A, Mayer G, Wohnsland S, Wagenlechner P, Leuschner M, Kreusser MM, Sommerer C, Rupp C, Friederich HC, Schultz JH, Bruns B. Psychosocial Characteristics of Patients Evaluated for Kidney, Liver, or Heart Transplantation. Psychosom Med. 2023 Jan 1;85(1):98-105.
• Bruns B, Daub R, Schmitz T, Hamze-Sinno M, Spaich S, Dewenter M, Schwale C, Gass P, Vogt M, Katus H, Herzog W, Friederich HC, Frey N, Schultz JH, Backs J. Forebrain corticosteroid receptors promote post-myocardial infarction depression and mortality. Basic Res Cardiol. 2022 Sep 6;117(1):44
• Omerovic E, Citro R, Bossone E, Redfors B, Backs J, Bruns B, Ciccarelli M, Couch LS, Dawson D, Grassi G, Iacoviello M, Parodi G, Schneider B, Templin C, Ghadri JR, Thum T, Chioncel O, Tocchetti CG, van der Velden J, Heymans S, Lyon AR. Pathophysiology of Takotsubo syndrome - a joint scientific statement from the Heart Failure Association Takotsubo Syndrome Study Group and Myocardial Function Working Group of the European Society of Cardiology - Part 1: overview and the central role for catecholamines and sympathetic nervous system. Eur J Heart Fail. 2022 Feb;24(2):257-273.
• Omerovic E, Citro R, Bossone E, Redfors B, Backs J, Bruns B, Ciccarelli M, Couch LS, Dawson D, Grassi G, Iacoviello M, Parodi G, Schneider B, Templin C, Ghadri JR, Thum T, Chioncel O, Tocchetti CG, van der Velden J, Heymans S, Lyon AR. Pathophysiology of Takotsubo syndrome - a joint scientific statement from the Heart Failure Association Takotsubo Syndrome Study Group and Myocardial Function Working Group of the European Society of Cardiology - Part 2: vascular pathophysiology, gender and sex hormones, genetics, chronic cardiovascular problems and clinical implications. Eur J Heart Fail. 2022 Feb;24(2):274-286
• Bruns B, Schmitz T, Diemert N, Schwale C, Werhahn SM, Weyrauther F, Gass P, Vogt MA, Katus H, Herzog W, Backs J, Schultz JH. Learned helplessness reveals a population at risk for depressive-like behaviour after myocardial infarction in mice. ESC Heart Fail. 2019 Aug;6(4):711-722. 

Research group members:

• Bastian Bruns, MD (PI)
• Marilena Antoniou, MD
• Stefanie Martinache (technical assistant and study nurse)
• Ole Anhuef, MD
• Nesrin Elsous, MD 
• Wan-Yu Jen (PhD candidate)
• Maximilian Joos (MD candidate)
• Henning Wiche (MD candidate)
• Katharina Westerholt (MD candidate)

If you are interested to join our team, feel free to contact us at any time via email: 

bastian.bruns(at)med.uni-heidelberg.de