Brain–heart axis: Advances in clinical insights and future technologies

The brain–heart axis is a complex bidirectional communication system involving neural, hormonal, and inflammatory pathways that mutually influence cardiovascular and neurological function. Disruption of this axis may play an important role in the pathogenesis and progression of both cardiovascular and neurological disorders. Stroke and acute brain injury may trigger cardiac dysfunction through proposed mechanisms of sympathetic hyperactivity, neuroinflammation, and oxidative stress. Takotsubo syndrome is widely considered a clinical example of cardiac dysfunction associated with extreme psychological stress, potentially mediated by catecholamine excess and autonomic imbalance. Autonomic dysfunction, characterized by sympathetic overactivity and parasympathetic withdrawal, has been frequently observed in brain–heart disorders, and heart rate variability is widely used as a potential biomarker of this dysregulation. Despite recent mechanistic insights, significant knowledge gaps remain regarding the relative contributions of different pathophysiological pathways, long-term consequences of brain–heart axis dysfunction, and optimal therapeutic strategies. This review aims to summarize recent clinical insights into brain–heart axis dysfunction and highlight emerging technologies for monitoring, diagnosis, and personalized intervention. Wearable monitoring devices and machine learning algorithms enable early detection of pathological changes and personalized interventions. Ultimately, a paradigm shift from organ-specific to integrated brain–heart precision medicine strategies is necessary to improve outcomes in this vulnerable patient population. Achieving this vision demands cross-disciplinary collaboration, standardization of data-collection and analysis protocols, and robust validation studies to translate discoveries into transformative clinical applications.