Katano Takehiro, Mori Hitoshi, Suda Satoshi
Department of Neurology, Nippon Medical School, Tokyo 113-8602, Japan.
Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan.
J Clin Med. 2025 Aug 26;14(17):6044. doi: 10.3390/jcm14176044.
The global aging population has led to a growing prevalence of heart failure (HF), signaling a new era often referred to as the HF pandemic. HF is strongly associated with both ischemic and hemorrhagic stroke, contributing to the global burden of cerebrovascular disease. In particular, ischemic stroke is frequently observed in patients with HF due to the common coexistence of atrial fibrillation (AF). Given that stroke and HF are both major causes of morbidity and mortality worldwide, a comprehensive understanding of their interrelationship is essential. In 2021, HF was redefined as "a clinical syndrome characterized by symptoms and signs resulting from structural and/or functional cardiac abnormalities, accompanied by current or prior evidence of elevated natriuretic peptides and/or objective findings of pulmonary or systemic congestion," and it is now classified according to ejection fraction. Among these categories, heart failure with reduced ejection fraction (HFrEF) has been the focus of extensive research, and its treatment has significantly advanced with the development of the so-called "Fantastic Four" pharmacologic therapies. A deeper understanding of the pathophysiological interplay between HF and stroke is crucial to inform future research and improve clinical practice. This review aims to comprehensively summarize the pathophysiological and clinical interrelationship between heart failure and stroke and to provide updated insights for future research and clinical management.
全球人口老龄化导致心力衰竭（HF）的患病率不断上升，标志着一个常被称为HF大流行的新时代。HF与缺血性和出血性中风密切相关，加重了全球脑血管疾病负担。特别是，由于心房颤动（AF）的常见共存，HF患者经常发生缺血性中风。鉴于中风和HF都是全球发病和死亡的主要原因，全面了解它们之间的相互关系至关重要。2021年，HF被重新定义为“一种临床综合征，其特征是由心脏结构和/或功能异常引起的症状和体征，伴有当前或先前利钠肽升高的证据和/或肺或全身充血的客观表现”，现在根据射血分数进行分类。在这些类别中，射血分数降低的心力衰竭（HFrEF）一直是广泛研究的重点，随着所谓“神奇四侠”药物疗法的发展，其治疗有了显著进展。深入了解HF与中风之间的病理生理相互作用对于为未来研究提供信息和改善临床实践至关重要。本综述旨在全面总结心力衰竭与中风之间的病理生理和临床相互关系，并为未来研究和临床管理提供最新见解。
