High risk of heart failure after stroke

After a stroke there is an increased risk of heart failure

It has long been known that people with heart failure develop strokes more often than average. German researchers have now shown that often the reverse course of disease occurs. After a stroke there is an increased risk of heart failure.

Connection between stroke and heart failure

Every year, more than a quarter of a million people in Germany suffer a stroke. The stroke is one of the leading causes of death in this country. In addition, it leads in many cases to permanent disability and secondary diseases. One of them can also be heart failure, as German researchers have now found out.

People with heart failure suffer strokes more often than average. But the reverse course of disease also occurs: after a stroke heart failure can develop. (Image: Syda Productions / fotolia.com)

Influence on the treatment of stroke patients

It has been known for some time that people with cardiac insufficiency (heart failure) experience strokes more often than average.

Scientists from the Universities of Würzburg and Duisburg-Essen (UDE) have now been able to show experimentally for the first time that the opposite course of the disease often occurs: After a stroke, heart failure can develop over a period of months.

They report about this and about therapeutic options in the journal "Annals of Neurology".

As a statement from the UDE states, the discovery of scientists and physicians has a potential impact on the treatment of stroke patients.

"In stroke, not only the brain function must be considered, also a long-term heart diagnostics must be envisaged," said Prof. Christoph Kleinschnitz of the Department of Neurology of the Medical Faculty of the University of Essen.

Hardly anything known about the long-term consequences

There has already been evidence that heart failure (HI) may develop through autonomic disorder. The exact mechanism behind it, however, was unknown.

Previous studies in stroke patients have shown that cardiac arrhythmias, myocardial cell death, and functional heart disorders can occur for up to several weeks after a stroke.

Within the first three months after a stroke, 19 percent of all patients experience a major cardiac incident: a heart attack or a sudden cardiac death.

But so far, little was known about the long-term consequences of a stroke on the development of chronic heart failure.

Dysfunction of the heart after stroke

Through the close collaboration of neurologists, cardiologists, and clinical epidemiologists from the University Hospitals and the German Center for Heart Failure (DZHI), the SICFAIL (stroke-related deterioration of the heart) project has now been able to monitor, evaluate, and evaluate the importance of stroke-induced heart failure develop new treatment strategies.

SICFAIL consists of an experimental and a clinical part that has not ended yet.

"The basic hypothesis is that IS (ischemic stroke triggered by sudden hypoperfusion of the brain) induces chronic heart failure (HI) and is generally accessible to pharmacological intervention," said scientist Dr. Michael Bieber from the University Hospital Würzburg.

An important milestone for this was the proof that after an experimental stroke actually a dysfunction of the heart is formed. Thus, the pump function was significantly reduced eight weeks after stroke induction.

This neurocardial damage is triggered by a chronic overactivation in a part of the nervous system, the sympathetic nervous system. This problem also leads to increased collagen formation directly at the heart.

Pharmacological strategy

The scientists tested a pharmacological strategy to prevent HI after stroke. As was the case with HI patients, the beta-blocker metoprolol was administered.

This lowered sympathetic activation, significantly improved cardiac function, and left no morphological changes in the heart.

"If the experimental results in the clinical part of the SICFAIL study can be confirmed, this drug therapy with a beta-blocker could also be a useful starting point for patients after a stroke," explained Prof. Stefan Frantz, cardiologist and director of the Medical Clinic and Polyclinic I at the University Hospital Würzburg.

"Recruitment and baseline clinical trials were successfully completed mid-year. Currently, the annual follow-up surveys are ongoing. The results of the first analyzes are expected early next year, "added Prof. Peter Heuschmann, Head of the Department of Clinical Epidemiology and Biometry at the Julius Maximilians University (JMU) Würzburg. (Ad)