Cardiac interoception as a mechanistic link between congenital mitral valve prolapse and anxiety disorders: from circuit dissection to neurotechnological modulation

Abstract

Interoception represents the brain’s ability to sense and interpret internal bodily signals, integrating cardiovascular, autonomic, and cortical processes to maintain homeostasis and shape emotional states. Cardiac interoception links physiological signals with affective experience. Mitral valve prolapse (MVP), a common valvular condition, is frequently associated with anxiety and autonomic dysfunction, yet its mechanisms remain poorly understood. Altered valve mechanics in MVP may modify baroreceptor signaling and autonomic balance, potentially contributing to distorted afferent input and heightened interoceptive sensitivity, although direct evidence for this pathway in MVP patients is currently lacking. Experimental optogenetic studies in animal models demonstrate that cardiac afferent modulation can causally influence anxiety-related behaviors, providing mechanistic proof-of-concept rather than direct evidence in MVP. Brain–computer interfaces (BCIs) using heartbeat-evoked potentials are being explored as experimental tools for real-time assessment and closed-loop neurofeedback, though clinical translation remains preliminary. Cardiac interoception offers a candidate, hypothesis-generating framework linking cardiac pathology and neuropsychiatric symptoms. Future work integrating circuit-level insights with BCI-based monitoring may help clarify whether earlier detection and personalized interventions can improve outcomes in MVP-related anxiety.