A multidimensional and multi-feature framework for cardiac interoception
Open accessAbstract
Interoception (the sensing of inner-body signals) is a multi-faceted construct with major relevance for basic and clinical neuroscience research. However, the neurocognitive signatures of this domain (cutting across behavioral, electrophysiological, and fMRI connectivity levels) are rarely reported in convergent or systematic fashion. Additionally, various controversies in the field might reflect the caveats of standard interoceptive accuracy (IA) indexes, mainly based on heartbeat detection (HBD) tasks. Here we profit from a novel IA index (md) to provide a convergent multidimensional and multi-feature approach to cardiac interoception. We found that outcomes from our IA-md index are associated with -and predicted by- canonical markers of interoception, including the hd-EEG-derived heart-evoked potential (HEP), fMRI functional connectivity within interoceptive hubs (insular, somatosensory, and frontal networks), and socio-emotional skills. Importantly, these associations proved more robust than those involving current IA indexes. Furthermore, this pattern of results persisted when taking into consideration confounding variables (gender, age, years of education, and executive functioning). This work has relevant theoretical and clinical implications concerning the characterization of cardiac interoception and its assessment in heterogeneous samples, such as those composed of neuropsychiatric patients.
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The hybrid approach of using group-level statistical analysis for dimensionality reduction has been employed in previous studies.
“This hybrid approach has been employed in previous studies (Dottori et al., 2017; Fittipaldi et al., 2020; Gonzalez Campo et al., 2020; Kassraian-Fard et al., 2016; McMillan et al., 2012).”
From Multiclass characterization of frontotemporal dementia variants via multimodal brain network computational inference (2023) · cites this paper as Fittipaldi et al., 2020
The extent to which deficits in interoceptive accuracy contribute to emotion recognition impairments in some dementia has been surprisingly underexplored.
“Despite increasing recognition of the role of interoception in emotion processing (Adolfi et al., 2017; Couto et al., 2015; Critchley & Garfinkel, 2017; Critchley & Harrison, 2013; Fittipaldi et al., 2020; Salamone et al., 2021; Yoris et al., 2020), the extent to which deficits in interoceptive accuracy contribute to the well-recognised emotion recognition impairments in some dementia has”
From Thinking versus feeling: How interoception and cognition influence emotion recognition in behavioural-variant frontotemporal dementia, Alzheimer's disease, and Parkinson's disease (2023) · cites this paper as Fittipaldi et al., 2020
Response windows that did not meet the specified threshold of regularity (coefficient of variation > 0.5) were not included in the final mean distance index calculation.
“Response windows that did not meet the specified threshold of regularity (coefficient of variation > 0.5) were not included in the final mean distance index calculation (see supplementary materials; de la Fuente et al., 2019; Fittipaldi et al., 2020).”
From Thinking versus feeling: How interoception and cognition influence emotion recognition in behavioural-variant frontotemporal dementia, Alzheimer's disease, and Parkinson's disease (2023) · cites this paper as Fittipaldi et al., 2020
Interoception is involved in emotion processing.
“Despite increasing recognition of the role of interoception in emotion processing (Adolfi et al., 2017; Couto et al., 2015; Critchley & Garfinkel, 2017; Critchley & Harrison, 2013; Fittipaldi et al., 2020; Salamone et al., 2021; Yoris et al., 2020), the extent to which deficits in interoceptive accuracy contribute to the well-recognised emotion recognition impairments in some dementia has”
From Thinking versus feeling: How interoception and cognition influence emotion recognition in behavioural-variant frontotemporal dementia, Alzheimer's disease, and Parkinson's disease (2023) · cites this paper as Fittipaldi et al., 2020
The mean distance index method is free of the bias present in other approaches and yields more robust responses.
“This method is free of the bias present in other approaches (regarding average estimation, number of tracked responses, time-locking assessment, and heart rate fluctuations), and yields more robust responses (de la Fuente et al., 2019; Fittipaldi et al., 2020).”
From Thinking versus feeling: How interoception and cognition influence emotion recognition in behavioural-variant frontotemporal dementia, Alzheimer's disease, and Parkinson's disease (2023) · cites this paper as Fittipaldi et al., 2020
The task employed here reduced attentional and memory-related task demands.
“This adaptation reduced attentional and memory-related task demands.”
From Thinking versus feeling: How interoception and cognition influence emotion recognition in behavioural-variant frontotemporal dementia, Alzheimer's disease, and Parkinson's disease (2023) · cites this paper as Fittipaldi et al., 2020
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Self-citationInteroceptive inference: homeostasis and decision-making
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Self-citationImplicit memory for emotional words is modulated by cardiac perception
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Self-citationMultimodal neurocognitive markers of interoceptive tuning in smoked cocaine
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Self-citationImpaired Interoceptive Accuracy in Semantic Variant Primary Progressive Aphasia
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Interoceptive rhythms in the brain
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Time is body: multimodal evidence of crosstalk between interoception and time estimation
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Self-citationMetacognition of emotion recognition across neurodegenerative diseases
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Self-citationAttention to cardiac sensations enhances the heartbeat-evoked potential during exhalation
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Intrinsic timescales and predictive allostatic interoception in brain health and disease
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Self-citationDynamic neurocognitive changes in interoception after heart transplant
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Self-citationExpectation predicts performance in the mental heartbeat tracking task
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Self-citationMulticentric evidence of emotional impairments in hypertensive heart disease
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Self-citationConfounding effects of heart rate, breathing rate, and frontal fNIRS on interoception
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Modulation of heartbeat-evoked potential and cardiac cycle effect by auditory stimuli
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Toward a multidisciplinary neurobiology of interoception and mental health
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Self-citationCardiac interoception in Anorexia Nervosa: A resting‐state heartbeat‐evoked potential study
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Heartbeat evoked potentials reflect interoceptive awareness during an emotional situation
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Allostatic interoception and brain health: From neurodegeneration to social adversities
Migeot, J., & Ibáñez, A. (2025) · Encyclopedia of the Human Brain · doi:10.1016/b978-0-12-820480-1.00025-5 · Cited by 10 · see citing works
Self-citationGonzalez-Gomez, R., Ibañez, A., & Moguilner, S. (2023) · Network Neuroscience · doi:10.1162/netn_a_00285 · Cited by 10 · see citing works
Self-citationHaruki, Y., Kaneko, K., & Ogawa, K. (2025) · BMC Psychology · doi:10.1186/s40359-025-02432-6 · Cited by 10 · see citing works
Parrotta, E., Bach, P., Perrucci, M. G., Costantini, M., & Ferri, F. (2024) · Cognition · doi:10.1016/j.cognition.2024.105719 · Cited by 14 · see citing works
Butler, M., Bird, C., Maggio, C., Durden, A., Modlin, N. L., Campbell‐Coker, K., Edwards, M. J., Pick, S., Millman, L. S. M., Lowery, E., et al. (2024) · Wellcome Open Research · doi:10.12688/wellcomeopenres.22543.1 · Cited by 8 · see citing works
Disentangling interoception and its links to cognitive functioning in fibromyalgia
Agostinho, M. R., Capelas, M. L., Pimentel-Santos, F. M., & Canaipa, R. (2025) · Scientific Reports · doi:10.1038/s41598-025-15087-5 · Cited by 8 · see citing works
What Can We Sense? Interoceptive Accuracy
Köteles, F. G. (2021) · Springer eBooks · doi:10.1007/978-3-030-63201-4_4 · Cited by 7 · see citing works
González-Gómez, R., Rodríguez‐Villagra, O. A., Schulte, M., Torralva, T., Ibáñez, A. M., Huepe, D., & Fittipaldi, S. (2021) · Cortex · doi:10.1016/j.cortex.2021.08.015 · Cited by 7 · see citing works
Self-citationNeuroanatomical markers of social cognition in neglected adolescents
Trujillo, C., Sainz‐Ballesteros, A., Suarez-Ardila, F., González-Gadea, M. L., Ibáñez, A. M., Herrera, E., & Báez, S. (2024) · Neurobiology of Stress · doi:10.1016/j.ynstr.2024.100642 · Cited by 7 · see citing works
Self-citationAltered processing of self-produced sensations in psychosis at cortical and spinal levels
Salamone, P., Enmalm, A., Kaldewaij, R., Åman, M., Medley, C., Pietrzak, M., Olausson, H., Capusan, A. J., & Boehme, R. (2025) · Molecular Psychiatry · doi:10.1038/s41380-025-03130-w · Cited by 6 · see citing works
Self-citationSteinfath, T. P., Azanova, M., Kapralov, N., Loesche, T., Enk, L., Nikulin, V. V., & Villringer, A. (2026) · Psychophysiology · doi:10.1111/psyp.70297 · Cited by 6 · see citing works
Impaired interoception in Colombian victims of armed conflict with PTSD: a preliminary HEP study
Herrera, E., Gutiérrez-Sterling, D., Barrera-Ocampo, A. A., Jaramillo, J. O., Santamaría‐García, H. A., & Birba, A. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1567574 · Cited by 5 · see citing works
Self-citationImpact of interoception and multisensory integration on functional and physical activities in aging
Pasciucco, M. R., Nunziata, S., Iuliano, S., Perrucci, M. G., Costantini, M., Ruggiero, G., & Ferri, F. (2025) · Cortex · doi:10.1016/j.cortex.2025.11.010 · Cited by 5 · see citing works
Folz, J., Nikolić, M., & Kret, M. E. (2024) · Scientific Reports · doi:10.1038/s41598-024-70299-5 · Cited by 6 · see citing works
Pasciucco, M. R., Perrucci, M. G., Croce, P., Kalckert, A., Costantini, M., & Ferri, F. (2025) · Scientific Reports · doi:10.1038/s41598-025-89951-9 · Cited by 5 · see citing works
Rominger, C., Fink, A., Perchtold‐Stefan, C. M., Schlögl, L., & Schwerdtfeger, A. R. (2025) · Psychophysiology · doi:10.1111/psyp.70051 · Cited by 5 · see citing works
Lanfranco, R. C., Sousa, F. D. S., Wessel, P. M., Rivera-Rei, Á. A., Bekinschtein, T. A., Lucero, B. A., Canales‐Johnson, A., & Huepe, D. (2024) · Cortex · doi:10.1016/j.cortex.2024.03.004 · Cited by 6 · see citing works
Self-citationFittipaldi, S., Armony, J. L., García, A. M., Migeot, J., Cadaveira, M., Ibáñez, A. M., & Báez, S. (2023) · Scientific Reports · doi:10.1038/s41598-023-27709-x · Cited by 5 · see citing works
Self-citationPratviel, Y., Bouni, A., Deschodt‐Arsac, V., Larrue, F., & Arsac, L. M. (2022) · Frontiers in Virtual Reality · doi:10.3389/frvir.2022.954808 · Cited by 9 · see citing works
Exploring the Link Between Interoception and Symptom Severity in Premature Ventricular Contractions
Limonova, A. S., Minenko, I. A., Sukmanova, A. A., Kutsenko, V. A., Kulikova, S. P., Nazarova, M. A., Davtyan, K. V., Drapkina, O. M., & Ershova, A. I. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13247756 · Cited by 4 · see citing works
Minenko, I. A., Limonova, A. S., Sukmanova, A. A., Kutsenko, V. A., Nazarova, M. A., Ershova, A. I., & Drapkina, O. M. (2025) · Scientific Reports · doi:10.1038/s41598-025-08779-5 · Cited by 4 · see citing works
Exploring brain-heart interactions: advances in physiological signal fusion for healthcare
Shi, Q., Shi, L., Chao, J., Liu, J., Zhang, L., Tian, F., Xu, C., & Hu, B. (2025) · Information Fusion · doi:10.1016/j.inffus.2025.103950 · Cited by 4 · see citing works
Lenglin, V., Wong, S., O’Callaghan, C., Erzinçlioğlu, S., Hornberger, M., Lebouvier, T., Piguet, O., Bourgeois‐Gironde, S., & Bertoux, M. (2022) · Cortex · doi:10.1016/j.cortex.2022.12.009 · Cited by 2 · see citing works
The Neural Basis of Interoception
Terasawa, Y., & Brewer, R. (2024) · Springer eBooks · doi:10.1007/978-3-031-68521-7_3 · Cited by 2 · see citing works
Factors Linking Interoception and Sleep Across the Adult Lifespan
Seo, A., Nishiyama, R., Lee, K., & Duarte, A. (2025) · Psychophysiology · doi:10.1111/psyp.70120 · Cited by 1 · see citing works
Baiano, C., Morgante, F., Goeta, D., Giacobbe, C., Amboni, M., Vitale, C., Makovac, E., Demartini, B., Santangelo, G., & Ricciardi, L. (2025) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.70187 · Cited by 1 · see citing works
Pasciucco, M. R., Bubbico, F., Nunziata, S., Iuliano, S., Ruggiero, G., Perrucci, M. G., Croce, P., Costantini, M., & Ferri, F. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1689759 · Cited by 1 · see citing works
Xie, Q., Zhou, X., Wen, Y., Li, Y., & Chen, X. (2023) · Chinese Science Bulletin (Chinese Version) · doi:10.1360/tb-2023-0592 · Cited by 1 · see citing works
Comparison of methods for cardiac interoception self-assessment
Minenko, I. A., Germanova, K., Limonova, A. S., Sukmanova, A. A., Iashvili, N., Nikulin, V. V., Kutsenko, V. A., Egorenkova, Е. E., Nazarova, M. A., Ershova, A. I., et al. (2023) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2023-3797 · Cited by 1 · see citing works
Suzman, E., Williams, Z. J., Feldman, J. I., Failla, M. D., Cascio, C. J., Wallace, M. T., Niarchou, M., Sutcliffe, J. S., Wodka, E., & Woynaroski, T. G. (2020) · doi:10.21203/rs.3.rs-135773/v1
Fittipaldi, S., Armony, J. L., García, A. M., Migeot, J., Cadaveira, M., Ibáñez, A. M., & Báez, S. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4105137
Self-citationCriscuolo, A. (2024) · doi:10.26481/dis.20240425ac
Bodily Self-Dysfunction in Psychosis: Altered Neural and Spinal Response to Self-produced SensationsPreprint
Salamone, P., Enmalm, A., Kaldewaij, R., Åman, M., Medley, C., Pietrzak, M., Olausson, H., Capusan, A. J., & Boehme, R. (2025) · medRxiv · doi:10.1101/2025.01.28.25321269
Self-citationInteroception and Social Cognition in Dementias
Hazelton, J. L., Ibáñez, A. M., & Kumfor, F. (2024) · Springer eBooks · doi:10.1007/978-3-031-32046-0_49-1
Self-citationInteroception and Social Cognition in Dementias
Hazelton, J. L., Ibáñez, A. M., & Kumfor, F. (2025) · Springer eBooks · doi:10.1007/978-3-031-73363-5_49
Self-citationSuzman, E., Williams, Z. J., Feldman, J. I., Failla, M. D., Cascio, C. J., Wallace, M., Niarchou, M., Sutcliffe, J. S., Wodka, E. L., & Woynaroski, T. G. (2021) · Figshare · doi:10.6084/m9.figshare.14746765
Schmitz, M., Back, S. N., Seitz, K. I., Harbrecht, N. K., Streckert, L., Schulz, A., Herpertz, S. C., & Bertsch, K. (2024) · Figshare · doi:10.6084/m9.figshare.26568196
Sasaoka, T., Maekawa, T., & Yamawaki, S. (2026) · Scientific Reports · doi:10.1038/s41598-026-41447-w
Acute running improves mood via changes in interoceptive sensibilityPreprint
Fujihara, H., & Kuwamizu, R. (2026) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2026.06.08.730632
Physiological correlates of interoception and the effect of heart rate variability biofeedback
Schumann, A., Schmitt, L., Rieger, K., Çalışkan, E., de la Cruz, F., Geisler, M., Gupta, Y., & Bär, K. (2026) · Frontiers in Network Physiology · doi:10.3389/fnetp.2026.1846014
Socioeconomic status impacts metacognition of working memory and emotion recognition
Migeot, J., Wen, O., Olivares, D., Morales, J.-P., Franco-O´Byrne, D., Rodríguez‐Villagra, O. A., Ibáñez, A. M., & Huepe, D. (2026) · Neuroscience · doi:10.1016/j.neuroscience.2026.07.006
Self-citationInteroception as a Mechanism Linking Anxiety, Cardiovascular Disease, and their Co-Occurrence
Keller, B. L., & Farris, S. G. (2026) · Current Cardiology Reports · doi:10.1007/s11886-026-02421-0
- Authors
- Fittipaldi, S., Abrevaya, S., Fuente, A. D. L., Pascariello, G. O., Hesse, E., Birba, A., Salamone, P., Hildebrandt, M., Martí, S. A., Pautassi, R. M., Huepe, D., Martorell, M. M., Yoris, A., Roca, M., García, A. M., Sedeño, L., & Ibáñez, A.
- Affiliations
- Consejo Nacional de Investigaciones Científicas y Técnicas (AR)
- Adolfo Ibáñez University (CL)
- Corresponding author
- Ibáñez, Agustín
- ORCID
- Venue
- NeuroImage
- Publisher
- Elsevier BV
- Published
- 2020-05
- Volume
- 212
- Pages
- 116677
- ISSN
- 1053-8119 (ISSN-L)
- PMC
- PMC7165068
- OpenAlex
- W3007193011
- Cited by
- 90
- References
- 137
- Citations by year
- 2026: 7 · 2025: 16 · 2024: 14 · 2023: 15 · 2022: 13 · 2021: 17 · 2020: 8
- FWCI
- 9.66
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- NeuroImage (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Conicet (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute on Aging
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Cognitive Neuroscience › Tactile and Sensory Interactions
- Keywords
- cardiac interoception, interoceptive accuracy, heart rate variability, insula, somatosensory cortex, frontal network, functional connectivity, socioemotional skills, neuropsychiatric patients
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Awareness, Brain, Electroencephalography, Evoked Potentials, Female, Heart, Heart Rate, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Young Adult, Interoception
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