Heart failure in acute ischemic stroke.

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.