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Altered heartbeat perception sensitivity associated with brain structural alterations in generalised anxiety disorder
  1. Hui Li1,
  2. Bin Zhang2,
  3. Qiang Hu1,
  4. Lanlan Zhang3,
  5. Yi Jin4,
  6. Jijun Wang1,
  7. Huiru Cui1,
  8. Jiaoyan Pang5,6 and
  9. Chunbo Li1
  1. 1 Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  2. 2 Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
  3. 3 Department of Psychiatry, Suzhou Guangji Hospital, Suzhou, China
  4. 4 Institute of Psychology, Chinese Academy of Sciences, Shanghai, China
  5. 5 Department of Psychology, Shanghai University of Political Science and Law, Shanghai, China
  6. 6 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  1. Correspondence to Dr Chunbo Li; licb{at}


Background Palpitation is a common complaint in generalised anxiety disorder (GAD). Brain imaging studies have investigated the neural mechanism of heartbeat perception in healthy volunteers. This study explored the neuroanatomical differences of altered heartbeat perception in patients with GAD using structural MRI.

Aims Based on the strong somatic-interoceptive symptoms in GAD, we explored the regional structural brain abnormalities involved in heartbeat perception in patients with GAD.

Methods This study was applied to the a priori regions using neuroanatomical theories of heartbeat perception, including the insula, anterior cingulate cortex, supplementary motor area and prefrontal cortex. A total of 19 patients with GAD and 19 healthy control subjects were enrolled. We used the FMRIB Software Library voxel-based morphometry software for estimating the grey matter volume of these regions of interest and analysed the correlation between heartbeat perception sensitivity and the volume of abnormal grey matter.

Results Patients with GAD showed a significantly decreased volume of grey matter in their left medial prefrontal cortex, right orbital frontal cortex and anterior cingulate cortex. The grey matter volume of the left medial prefrontal cortex negatively correlated with heartbeat perception sensitivity in patients with GAD.

Conclusions It should be the first study that shows heartbeat perception is associated with brain structure in GAD. Our findings suggest that the frontal region may play an important role in aberrant heartbeat perception processing in patients with GAD, and this may be an underlying mechanism resulting in the abnormal cardiovascular complaints in GAD. This is hypothesised as a ‘top-down’ deficiency, especially in the medial prefrontal cortex. This will provide the foundation for a more targeted region for neuromodulation intervention in the future.

  • generalised anxiety disorder
  • structural MRI
  • grey matter volume
  • heartbeat perception sensitivity
  • medial prefrontal cortex

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  • HL and BZ contributed equally.

  • Contributors CL and JW designed the project. BZ, HL, QH, LZ and HC performed the experiment. YJ analysed the MRI data and interpreted the results. HL and BZ wrote the manuscript. JP contributed to manuscript editing. CL handled the work of revising the manuscript. All authors have read and approved the final version of the manuscript.

  • Funding This work was supported by Shanghai Science and Technology Commission (16411965000; 18411952400), Shanghai Jiao Tong University Foundation (YG2016MS37), National Key R&D Program of China (2018YFC2001605, 2019YFA0706200), Natural Science Foundation of Shanghai (18ZR1432600, 81071098), Shanghai Municipal Commission of Health and Family Planning Foundation (20164Y0215).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. The data used to support the findings of this study have not been made available.

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