Cuadrado-Godia Elisa, Ois Angel, Roquer Jaume
Neurology Department, Hospital Universitari del Mar. Program on Research on Inflammatory and Cardiovascular Disorders, IMIM, Barcelona, Spain.
Curr Cardiol Rev. 2010 Aug;6(3):202-13. doi: 10.2174/157340310791658776.
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.
心力衰竭（HF）是一种复杂的临床综合征，可由任何损害心室充盈或射血能力的结构性或功能性心脏疾病引起。由于人口老龄化，近几十年来它已成为一个日益严重的公共卫生问题。HF的诊断基于临床，没有诊断性检测方法，尽管所有患者都应进行一些基本的辅助检测。根据射血分数（EF），该综合征可分为射血分数降低的HF或射血分数正常的HF（HFNEF）。尽管HF的预后较差，但HFNEF似乎相对良性。HF和缺血性卒中（IS）有共同的血管危险因素，如年龄、高血压、糖尿病、冠状动脉疾病和心房颤动。HF患者的IS发病率较高，在不同队列研究中每年从1.7%到10.4%不等。卒中发生率随随访时间延长而增加。EF降低，无论严重程度如何，都与较高的卒中风险相关。左心室质量和几何形状也与卒中发生率有关，其中同心性肥厚风险最大。在射血分数降低的HF中，卒中机制可能是栓塞、脑灌注不足或两者兼有，而在HFNEF中，机制更典型地与小血管的慢性内皮损伤有关。HF患者的卒中更严重，且与更高的复发率、依赖率以及短期和长期死亡率相关。这些患者的心脏发病率和死亡率也很高。HF患者急性卒中的治疗包括所有当前的治疗选择，以更谨慎地控制血压。对于二级预防，最佳控制所有血管危险因素至关重要。抗血栓治疗是必需的，尽管血小板抑制剂或抗凝药物的选择取决于心脏疾病。目前正在进行试验，以评估抗凝治疗对窦性心律且射血分数降低患者预防栓塞的效果。
