Myrmel Gard M S, Waje-Andreassen Ulrike, Pirinen Jani, Sinisalo Juha, Järvinen Vesa, Putaala Jukka, Saeed Sahrai
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Cardiology. 2025 Jan 7:1-15. doi: 10.1159/000543170.
Approximately 7.6 million individuals experience a new ischemic stroke each year, and roughly 25% of all ischemic strokes are cardiogenic in origin, carrying a high risk of recurrence, death, and disability. To prevent future ischemic strokes, especially in younger individuals, it is crucial to detect and treat direct and indirect cardioembolic sources.
Cardiac imaging is a rapidly evolving field, and post-stroke cardiac imaging is no longer limited to echocardiography but also includes other imaging techniques, such as cardiac magnetic resonance imaging and cardiac computed tomography. Clinicians must be familiar with numerous cardiac and systemic disorders related to stroke and consider the possibilities that imaging diagnostics have to offer. Additional diagnostic tests, such as pre- and transcranial ultrasound with a bubble test, can also increase the diagnostic accuracy for detecting right-left shunt embolisms. Moreover, a patent foramen ovale (PFO) has traditionally been considered as a minor or uncertain risk factor for ischemic stroke. However, PFO-associated strokes are a distinct category among the cardioembolic sources, as in most cases, we do not assume that the thrombus has been developed in situ in the PFO structure or elsewhere intracardially, rather, the PFO merely acts as a mediator for a paradoxical, venous embolism. The article has two parts: Part I, the heart-brain axis, describes multimodality cardiac imaging in the assessment of cardioembolic sources of ischemic stroke, with a special focus on disorders that traditionally have received little attention in the literature. Part II discusses the brain-heart axis, namely, when acute cerebrovascular events lead to cardiac dysfunction, for example, neurogenic stunned myocardium and Takotsubo syndrome.
Advances in cardiovascular imaging have significantly enhanced the detection of cardiac disorders associated with stroke. Clinicians involved in post-stroke workup need to be aware of the capabilities of different imaging modalities to ensure high diagnostic accuracy in order to effectively treat and prevent stroke recurrence.
每年约有760万人经历新发缺血性卒中，所有缺血性卒中中约25%起源于心源性，具有高复发、死亡和致残风险。为预防未来的缺血性卒中，尤其是在年轻个体中，检测和治疗直接和间接的心源性栓塞源至关重要。
心脏成像领域发展迅速，卒中后心脏成像不再局限于超声心动图，还包括其他成像技术，如心脏磁共振成像和心脏计算机断层扫描。临床医生必须熟悉与卒中相关的众多心脏和全身性疾病，并考虑成像诊断所提供的可能性。额外的诊断测试，如经颅超声心动图及气泡试验，也可提高检测左右分流性栓塞的诊断准确性。此外，卵圆孔未闭（PFO）传统上被认为是缺血性卒中的一个次要或不确定风险因素。然而，PFO相关卒中在心脏栓塞源中是一个独特类别，因为在大多数情况下，我们并不认为血栓是在PFO结构或心内其他部位原位形成的，相反，PFO仅作为反常性静脉栓塞的介质。本文分为两部分：第一部分，心脑轴，描述多模态心脏成像在评估缺血性卒中的心源性栓塞源中的应用，特别关注传统上在文献中很少受到关注的疾病。第二部分讨论脑心轴，即急性脑血管事件何时导致心脏功能障碍，例如神经源性心肌顿抑和应激性心肌病。
心血管成像的进展显著提高了与卒中相关的心脏疾病的检测率。参与卒中后检查的临床医生需要了解不同成像模态的能力，以确保高诊断准确性，从而有效治疗和预防卒中复发。
