Stroke–Heart Syndrome: Recent Advances and Challenges

Author:

Scheitz Jan F.12345ORCID,Sposato Luciano A.567ORCID,Schulz‐Menger Jeanette89,Nolte Christian H.1234ORCID,Backs Johannes1011,Endres Matthias123412ORCID

Affiliation:

1. Department of Neurology With Experimental Neurology Charité‐Universitätsmedizin Berlin Berlin Germany

2. Center for Stroke Research Berlin Charité‐Universitätsmedizin Berlin Berlin Germany

3. DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany

4. Berlin Institute of Health (BIH) Berlin Germany

5. World Stroke Organization Brain & Heart Task Force

6. Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry Western University London Ontario Canada

7. Heart & Brain Laboratory Western University London Ontario Canada

8. Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité–Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max‐Delbrueck Center for Molecular Medicine DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany

9. Department of Cardiology and Nephrology HELIOS Klinikum Berlin Buch Berlin Germany

10. Institute of Experimental Cardiology Heidelberg University Heidelberg Germany

11. DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim Heidelberg Germany

12. DZNE (German Center for Neurodegenerative Disease), Partner Site Berlin Berlin Germany

Abstract

After ischemic stroke, there is a significant burden of cardiovascular complications, both in the acute and chronic phase. Severe adverse cardiac events occur in 10% to 20% of patients within the first few days after stroke and comprise a continuum of cardiac changes ranging from acute myocardial injury and coronary syndromes to heart failure or arrhythmia. Recently, the term stroke–heart syndrome was introduced to provide an integrated conceptual framework that summarizes neurocardiogenic mechanisms that lead to these cardiac events after stroke. New findings from experimental and clinical studies have further refined our understanding of the clinical manifestations, pathophysiology, and potential long‐term consequences of the stroke–heart syndrome. Local cerebral and systemic mediators, which mainly involve autonomic dysfunction and increased inflammation, may lead to altered cardiomyocyte metabolism, dysregulation of (tissue‐resident) leukocyte populations, and (micro‐) vascular changes. However, at the individual patient level, it remains challenging to differentiate between comorbid cardiovascular conditions and stroke‐induced heart injury. Therefore, further research activities led by joint teams of basic and clinical researchers with backgrounds in both cardiology and neurology are needed to identify the most relevant therapeutic targets that can be tested in clinical trials.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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