Chen Zhili, Venkat Poornima, Seyfried Don, Chopp Michael, Yan Tao, Chen Jieli
From the Gerontology and Neurological Institute, Tianjin Medical University General Hospital, China (Z.C., T.Y., J.C.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V., D.S., M.C., J.C.); and Department of Physics, Oakland University, Rochester, MI (M.C.).
Circ Res. 2017 Aug 4;121(4):451-468. doi: 10.1161/CIRCRESAHA.117.311170.
Neurocardiology is an emerging specialty that addresses the interaction between the brain and the heart, that is, the effects of cardiac injury on the brain and the effects of brain injury on the heart. This review article focuses on cardiac dysfunction in the setting of stroke such as ischemic stroke, brain hemorrhage, and subarachnoid hemorrhage. The majority of post-stroke deaths are attributed to neurological damage, and cardiovascular complications are the second leading cause of post-stroke mortality. Accumulating clinical and experimental evidence suggests a causal relationship between brain damage and heart dysfunction. Thus, it is important to determine whether cardiac dysfunction is triggered by stroke, is an unrelated complication, or is the underlying cause of stroke. Stroke-induced cardiac damage may lead to fatality or potentially lifelong cardiac problems (such as heart failure), or to mild and recoverable damage such as neurogenic stress cardiomyopathy and Takotsubo cardiomyopathy. The role of location and lateralization of brain lesions after stroke in brain-heart interaction; clinical biomarkers and manifestations of cardiac complications; and underlying mechanisms of brain-heart interaction after stroke, such as the hypothalamic-pituitary-adrenal axis; catecholamine surge; sympathetic and parasympathetic regulation; microvesicles; microRNAs; gut microbiome, immunoresponse, and systemic inflammation, are discussed.
神经心脏病学是一个新兴的专业领域，它研究大脑与心脏之间的相互作用，即心脏损伤对大脑的影响以及脑损伤对心脏的影响。这篇综述文章聚焦于中风（如缺血性中风、脑出血和蛛网膜下腔出血）情况下的心脏功能障碍。大多数中风后死亡归因于神经损伤，而心血管并发症是中风后死亡的第二大原因。越来越多的临床和实验证据表明脑损伤与心脏功能障碍之间存在因果关系。因此，确定心脏功能障碍是由中风引发、是一种无关的并发症还是中风的潜在原因很重要。中风引起的心脏损伤可能导致死亡或潜在的终身心脏问题（如心力衰竭），或者导致轻度且可恢复的损伤，如神经源性应激性心肌病和Takotsubo心肌病。本文讨论了中风后脑损伤的位置和侧化在脑-心相互作用中的作用；心脏并发症的临床生物标志物和表现；以及中风后脑-心相互作用的潜在机制，如下丘脑-垂体-肾上腺轴；儿茶酚胺激增；交感神经和副交感神经调节；微泡；微小RNA；肠道微生物群、免疫反应和全身炎症。
