Download PDF
Aktuelle Neurologie 2017; 44(04): 267-271
DOI: 10.1055/s-0043-100214
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Bedeutung der Herzinsuffizienz für Prävention, Therapie und Prognose des ischämischen Schlaganfalls

Relevance of Heart Failure in Prevention, Treatment and Prognosis of Ischemic Stroke
Karl Georg Häusler
1   Klinik und Poliklinik für Neurologie, Charité – Universitätsmedizin Berlin
2   Centrum für Schlaganfallforschung Berlin, Charité – Universitätsmedizin Berlin
3   Kompetenznetz Vorhofflimmern e.V.
,
Matthias Endres
1   Klinik und Poliklinik für Neurologie, Charité – Universitätsmedizin Berlin
2   Centrum für Schlaganfallforschung Berlin, Charité – Universitätsmedizin Berlin
4   Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Berlin
5   Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Berlin
,
Wolfram Doehner
2   Centrum für Schlaganfallforschung Berlin, Charité – Universitätsmedizin Berlin
6   Klinik für Kardiologie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
19 May 2017 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Schätzungsweise 1,2 Mio. Bundesbürger leiden unter einer Herzinsuffizienz, darunter auch 13–29% aller Patienten, die einen ischämischen Schlaganfall erleiden. Eine bestehende Herzinsuffizienz ist aber nicht nur ein Risikofaktor für einen ischämischen Schlaganfall, sondern ist zudem mit einer höheren Krankheitsschwere und Sterblichkeit nach einem Schlaganfall assoziiert. Wenig ist hingegen über die Bedeutung einer Herzinsuffizienz für die Akuttherapie des ischämischen Schlaganfalls bekannt. In diesem Kontext beachtenswert ist zudem die Hypothese, dass ein Schlaganfall möglicherweise auch zu einer Verschlechterung bzw. zum Auftreten einer Herzinsuffizienz beitragen kann. Zur Schlaganfallprävention sollten herzinsuffiziente Patienten nur dann oral antikoaguliert werden, wenn ein Vorhofflimmern vorliegt. Der vorliegende Artikel fasst den aktuellen Kenntnisstand basierend auf einer selektiven Literaturrecherche sowie derzeit vorliegenden Leitlinienempfehlungen zusammen und gibt Empfehlungen für die klinische Praxis.

Abstract

About 1.2 million Germans suffer from heart failure (HF), including about 13–29% of all patients with acute ischemic stroke. HF is a risk factor for ischemic stroke and it is accompanied by high morbidity and mortality after stroke. So far, only limited data are available regarding the relevance of HF in acute ischemic stroke. The hypothesis that an acute ischemic stroke may contribute to deterioration and occurrence of heart failure seems to be relevant. Stroke prevention by oral anticoagulation is only recommended for HF patients with concomitant atrial fibrillation. This article is based on a selective literature review, summarizes the present knowledge as well as the resulting guideline recommendations and provides recommendations for clinical practice.

Schlüsselwörter

Herzinsuffizienz - ischämischer Schlaganfall - Schlaganfallprävention - orale Antikoagulation

Keywords

heart failure - ischemic stroke - stroke prevention - oral anticoagulation
 

  • Literatur

  • 1 Statistisches Bundesamt. Todesursachen in Deutschland. 2014; https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/ Todesursachen/Todesursachen2120400147004.pdf?__blob = publicationFile
    PubMed
  • 2 Statistisches Bundesamt. Diagnosedaten der Patienten und Patientinnen in Krankenhäusern. 2014; https://www.destatis.de/DE/ Publikationen/Thematisch/Gesundheit/Krankenhaeuser/Diagnoseda tenKrankenhaus2120621147004.pdf?__blob = publicationFile
    PubMed
  • 3 Zarrinkoub R, Wettermark B, Wändell P. et al. The epidemiology of heart failure, based on data for 2.1 million inhabitants in Sweden. Eur J Heart Fail 2013; 15: 995-1002
    CrossrefPubMedGoogle Scholar
  • 4 Ponikowski P, Voors AA, Anker SD. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016; 18: 891-975
    CrossrefPubMedGoogle Scholar
  • 5 Häusler KG, Laufs U, Endres M. Neurologische Aspekte bei chronischer Herzinsuffizienz. Nervenarzt 2011; 82: 733-742
    CrossrefPubMedGoogle Scholar
  • 6 Häusler KG, Laufs U, Endres M. Chronic Heart Failure and Ischemic Stroke. Stroke 2011; 42: 2977-2982
    CrossrefPubMedGoogle Scholar
  • 7 Häusler KG, Hellwig S, Döhner W. et al. Herzinsuffizienz als Risikofaktor für den akuten ischämischen Schlaganfall. Klinikarzt 2014; 43: 510-516
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Vemmos K, Ntaios G, Savvari P. et al. Stroke aetiology and predictors of outcome in patients with heart failure and acute stroke: a 10-year follow-up study. Eur J Heart Fail 2012; 14: 211-218
    CrossrefPubMedGoogle Scholar
  • 9 Abdul-Rahim AH, Perez AC, Fulton RL. et al. Risk of stroke in chronic heart failure patients without atrial fibrillation: analysis of the controlled rosuvastatin in multinational trial heart failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell’Insufficienza Cardiaca – Heart Failure (GISSI-HF) trials. Circulation 2015; 131: 1486-1494
    CrossrefPubMedGoogle Scholar
  • 10 Ferreira JP, Girerd N, Alshalash S. et al. Antithrombotic therapy in heart failure patients with and without atrial fibrillation: update and future challenges. Eur Heart J 2016; 37: 2455-2464
    CrossrefPubMedGoogle Scholar
  • 11 Kirchhof P, Benussi S, Kotecha D. et al. 2016; ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC)Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESCEndorsed by the European Stroke Organisation (ESO). Eur Heart J 2016; 37: 2893-2962
    CrossrefPubMedGoogle Scholar
  • 12 Melgaard L, Gorst-Rasmussen A, Lane DA. et al. Assessment of the CHA2DS2-VASc score in predicting ischemic stroke, thromboembolism, and death in patients with heart failure with and without atrial fibrillation. JAMA 2015; 314: 1030-1038
    CrossrefPubMedGoogle Scholar
  • 13 Freudenberger RS, Cheng B, Mann DL. et al. The first prognostic model for stroke and death in patients with systolic heart failure. J Cardiol 2016; 68: 100-103
    CrossrefPubMedGoogle Scholar
  • 14 Katsanos AH, Parissis J, Frogoudaki A. et al. Heart failure and the risk of ischemic stroke recurrence: A systematic review and meta-analysis. J Neurol Sci 2016; 362: 182-187
    CrossrefPubMedGoogle Scholar
  • 15 Hopper I, Skiba M, Krum H. Updated meta-analysis on antithrombotic therapy in patients with heart failure and sinus rhythm. Eur J Heart Fail 2013; 15: 69-78
    CrossrefPubMedGoogle Scholar
  • 16 Pullicino PM, Qian M, Sacco RL. et al. Recurrent stroke in the warfarin versus aspirin in reduced cardiac ejection fraction (WARCEF) trial. Cerebrovasc Dis 2014; 38: 176-181
    CrossrefPubMedGoogle Scholar
  • 17 Di Tullio MR, Qian M, Thompson JL. et al. Left ventricular ejection fraction and risk of stroke and cardiac events in heart failure: data from the warfarin versus aspirin in reduced ejection fraction trial. Stroke 2016; 47: 2031-2037
    CrossrefPubMedGoogle Scholar
  • 18 Lip GY, Ponikowski P, Andreotti F. et al. Thrombo-embolism and antithrombotic therapy for heart failure in sinus rhythm. A joint consensus document from the ESC Heart Failure Association and the ESC Working Group on Thrombosis. Eur J Heart Fail 2012; 14: 681-695
    CrossrefPubMedGoogle Scholar
  • 19 Zannad F, Greenberg B, Cleland JG. et al. Rationale and design of a randomized, double-blind, event-driven, multicentre study comparing the efficacy and safety of oral rivaroxaban with placebo for reducing the risk of death, myocardial infarction or stroke in subjects with heart failure and significant coronary artery disease following an exacerbation of heart failure: the COMMANDER HF trial. Eur J Heart Fail 2015; 17: 735-742
    CrossrefPubMedGoogle Scholar
  • 20 Xiong Q, Lau YC, Senoo K. et al. Non-vitamin K antagonist oral anticoagulants (NOACs) in patients with concomitant atrial fibrillation and heart failure: a systemic review and meta-analysis of randomized trials. Eur J Heart Fail 2015; 17: 1192-1200
    CrossrefPubMedGoogle Scholar
  • 21 Connolly SJ, Eikelboom J, Joyner C. et al. Apixaban in patients with atrial fibrillation. N Engl J Med 2011; 364: 806-817
    CrossrefPubMedGoogle Scholar
  • 22 Yancy CW, Jessup M, Bozkurt B. et al. 2013; ACCF/AHA guideline for the management of heart failure. J Am Coll Cardiol 2013: e147-e239
    PubMedGoogle Scholar
  • 23 McMurray JJ, Packer M, Desai AS. et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014; 371: 993-1004
    CrossrefPubMedGoogle Scholar
  • 24 Pullicino PM, Homma S. Stroke in heart failure: atrial fibrillation revisited?. J Stroke Cerebrovasc Dis 2010; 19: 1-2
    CrossrefPubMedGoogle Scholar
  • 25 Abdul-Rahim AH, Fulton RL, Frank B. et al. Associations of chronic heart failure with outcome in acute ischaemic stroke patients who received systemic thrombolysis: analysis from VISTA. Eur J Neurol 2015; 22: 163-169
    CrossrefPubMedGoogle Scholar
  • 26 Whiteley WN, Slot KB, Fernandes P. et al. Risk factors for intracranial hemorrhage in acute ischemic stroke patients treated with recombinant tissue plasminogen activator: a systematic review and meta-analysis of 55 studies. Stroke 2012; 43: 2904-2949
    CrossrefPubMedGoogle Scholar
  • 27 Liebeskind DS, Tomsick TA, Foster LD. et al. Collaterals at angiography and outcomes in the Interventional Management of Stroke (IMS) III trial. Stroke 2014; 45: 759-764
    CrossrefPubMedGoogle Scholar
  • 28 Rothwell PM, Algra A, Chen Z. et al. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials. Lancet 2016; 388: 365-375
    CrossrefPubMedGoogle Scholar
  • 29 Zhang S, He WB, Chen NH. Causes of death among persons who survive an acute ischemic stroke. Curr Neurol Neurosci Rep 2014; 14: 467
    CrossrefPubMedGoogle Scholar
  • 30 Wira 3rd CR. Rivers E, Martinez-Capolino C. et al. Cardiac complications in acute ischemic stroke. West J Emerg Med 2011; 12: 414-420
    CrossrefPubMedGoogle Scholar
  • 31 Holström A, Fu ML, Hjalmarsson C. et al. Heart dysfunction in patients with acute ischemic stroke or TIA does not predict all-cause mortality at long-term follow-up. BMC Neurology 2013; 13: 122
    CrossrefPubMedGoogle Scholar
  • 32 Byun JI, Jung KH, Kim YD. et al. Cardiac function and outcome in patients with cardio-embolic stroke. PLoS One 2014; 9: e95277
    CrossrefPubMedGoogle Scholar
  • 33 Kristensen SL, Jhund PS, Køber L. et al. Comparison of outcomes after hospitalization for worsening heart failure, myocardial infarction, and stroke in patients with heart failure and reduced and preserved ejection fraction. Eur J Heart Fail 2015; 17: 169-176
    CrossrefPubMedGoogle Scholar