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Impact of Intracardiac Neurons on Cardiac Electrophysiology and Arrhythmogenesis in an Ex Vivo Langendorff System
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Neurologic complications of cardiomyopathies and other myocardial disorders

John F Moran1

  • 1Division of Cardiology, Loyola University Medical Center, Maywood, IL, USA.

Handbook of Clinical Neurology
|December 25, 2013
PubMed

Insights

Cardiomyopathies can lead to myocardial dysfunction and increase stroke risk, particularly from atrial fibrillation. Anticoagulation therapy can reduce thrombotic events, but risks must be carefully evaluated.

Area of Science:

  • Cardiology
  • Neurology
  • Genetics

Background:

  • Cardiomyopathies, stemming from diverse causes like infections and genetic factors, frequently lead to myocardial dysfunction and congestive heart failure.
  • A significant link exists between heart disease, specifically myocardial dysfunction, and neurological complications, primarily embolic stroke.
  • Reduced left ventricular ejection fraction and mural thrombus formation are key indicators associated with increased embolic stroke risk.

Purpose of the Study:

  • To explore the relationship between cardiomyopathies, myocardial dysfunction, and the incidence of embolic strokes.
  • To highlight the role of atrial fibrillation as a primary source of thrombi and its impact on stroke risk.
  • To discuss the implications of patent foramen ovale in cryptogenic strokes and the utility of anticoagulation.

Main Methods:

  • Review of existing literature on cardiomyopathies, myocardial dysfunction, and cerebrovascular events.
  • Analysis of the association between left ventricular ejection fraction, mural thrombus, and embolic stroke prevalence.
  • Examination of the contribution of atrial fibrillation and patent foramen ovale to stroke risk.

Main Results:

  • Left ventricular dysfunction in cardiomyopathies is linked to mural thrombi, with embolic stroke prevalence ranging from 3% to 50%.
  • Atrial fibrillation, especially nonvalvular, significantly elevates stroke risk (4-7 times higher than normal sinus rhythm).
  • Clinically silent cerebral infarctions are detectable in dilated cardiomyopathy patients via advanced imaging.

Conclusions:

  • Myocardial dysfunction from cardiomyopathies necessitates careful evaluation for embolic stroke risk, with atrial fibrillation being a major contributor.
  • Anticoagulation is crucial for reducing thrombotic events but requires risk-benefit assessment using validated scores.
  • Genetic factors are increasingly important in understanding dilated cardiomyopathies, underscoring the need for thorough clinical assessment.

Keywords:
Embolic strokeatrial fibrillationcardiomyopathyleft ventricular dysfunctionpatent foramen ovale

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