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Published on: February 16, 2011
Heart failure in acute ischemic stroke
Elisa Cuadrado-Godia1, Angel Ois, Jaume Roquer
1Neurology Department, Hospital Universitari del Mar. Program on Research on Inflammatory and Cardiovascular Disorders, IMIM, Barcelona, Spain.
Insights
Heart failure (HF) patients face a higher risk of ischemic stroke (IS). Reduced ejection fraction (EF) and specific heart conditions increase stroke incidence, severity, and mortality in individuals with HF.
Area of Science:
- Cardiology and Neurology
- Public Health
Background:
- Heart failure (HF) is a growing public health concern due to population aging.
- HF diagnosis is clinical, with classification based on ejection fraction (EF): low EF or HF with normal EF (HFNEF).
- HF patients exhibit a higher incidence of ischemic stroke (IS), with rates varying from 1.7% to 10.4% annually.
Purpose of the Study:
- To explore the relationship between heart failure and ischemic stroke.
- To understand the differing stroke mechanisms in HF with low EF versus HFNEF.
- To highlight the increased severity and mortality of stroke in HF patients.
Main Methods:
- Review of clinical data and cohort studies on HF and IS incidence.
- Analysis of risk factors shared by HF and IS, including age, hypertension, diabetes, coronary artery disease, and atrial fibrillation.
- Examination of cardiac factors like reduced EF, left ventricular mass, and geometry influencing stroke risk.
Main Results:
- Reduced EF, regardless of severity, is linked to a higher stroke risk.
- Concentric hypertrophy is associated with the greatest stroke risk.
- Stroke in HF patients is more severe, with higher recurrence, dependency, and mortality rates.
- HFNEF stroke mechanisms are typically linked to chronic endothelial damage, unlike embolism or hypoperfusion in low EF HF.
Conclusions:
- Optimal management of vascular risk factors and antithrombotic therapy are crucial for secondary stroke prevention in HF patients.
- Ongoing trials are evaluating anticoagulant therapy for embolism prevention in specific HF populations.
- Stroke in HF patients carries significant morbidity and mortality, necessitating careful management and prevention strategies.
Abstract:
Heart failure (HF) is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. Due to the aging of the population it has become a growing public health problem in recent decades. Diagnosis of HF is clinical and there is no diagnostic test, although some basic complementary testing should be performed in all patients. Depending on the ejection fraction (EF), the syndrome is classified as HF with low EF or HF with normal EF (HFNEF). Although prognosis in HF is poor, HFNEF seems to be more benign. HF and ischemic stroke (IS) share vascular risk factors such as age, hypertension, diabetes mellitus, coronary artery disease and atrial fibrillation. Persons with HF have higher incidence of IS, varying from 1.7% to 10.4% per year across various cohort studies. The stroke rate increases with length of follow-up. Reduced EF, independent of severity, is associated with higher risk of stroke. Left ventricular mass and geometry are also related with stroke incidence, with concentric hypertrophy carrying the greatest risk. In HF with low EF, the stroke mechanism may be embolism, cerebral hypoperfusion or both, whereas in HFNEF the mechanism is more typically associated with chronic endothelial damage of the small vessels. Stroke in patients with HF is more severe and is associated with a higher rate of recurrence, dependency, and short term and long term mortality. Cardiac morbidity and mortality is also high in these patients. Acute stroke treatment in HF includes all the current therapeutic options to more carefully control blood pressure. For secondary prevention, optimal control of all vascular risk factors is essential. Antithrombotic therapy is mandatory, although the choice of a platelet inhibitor or anticoagulant drug depends on the cardiac disease. Trials are ongoing to evaluate anticoagulant therapy for prevention of embolism in patients with low EF who are at sinus rhythm.
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