Поражение сердца на фоне ишемического инсульта: что нового?

Ишемический инсульт и сердечно-сосудистые заболевания имеют множество общих факторов риска. Соответственно, пациенты, у которых имеются общие триггеры, подвержены высокому риску развития нарушений в оси «мозг-сердце». С 2018 года в структуре церебро-кардиальных взаимоотношений выделяется синдром «инсульт-сердце» (stroke–heart syndrome), включающий любые новые нарушения со стороны сердца или ухудшение имеющихся ранее заболеваний сердца, наблюдаемые в течение первых 30 дней после острого ишемического инсульта, пик развития которых приходится на первые 72 часа после неврологической катастрофы. Патогенетические механизмы этого синдрома в настоящее время активно изучаются. Основной причиной повреждения сердца на фоне инсульта считается дисфункция автономной нервной системы, которая проявляется в снижении парасимпатической и усилении симпатической активности, что проявляется в снижении вариабельности сердечного ритма и барорецепторного рефлекса. Инсульт также сопровождается активацией гипоталамо-гипофизарнонадпочечниковой оси и симпатоадреналовой системы, развитием системной воспалительной реакции и гиперкоагуляции. Недавние данные свидетельствуют о том, что в цереброкардиальном взаимодействии играют роль микро-РНК и кишечная микробиота.
В обзоре описаны современные представления о проявлениях данного типа острого цереброкардиального синдрома, возможностях его классификации и попытках фенотипирования, а также приведены современные эпидемиологические сведения. Обсуждаются диагностические возможности рутинных лабораторно-инструментальных обследований, а также перспективные методы, требующие дополнительных исследований.

1. Здравоохранение в России. М., Росстат. 2023. [Электронный ресурс]. URL: http://ssl.rosstat.gov.ru/storage/mediabank/Zdravoohran-2023.pdf (дата обращения: 21.08.2025

2. Десять основных причин смерти. Всемирная организация здравоохранения. [Электронный ресурс]. URL: https://www.who.int/ru/news-room/fact-sheets/detail/the-top-10-causes-of-death (дата обращения: 21.08.2025).

3. Chong B, Jayabaskaran J, Jauhari SM et al. Global burden of cardiovascular diseases: projections from 2025 to 2050. Eur J Prev Cardiol. 2024 Sep 13:zwae281. doi: 10.1093/eurjpc/zwae281.

4. Scott CA, Li L, Rothwell PM. Diverging Temporal Trends in Stroke Incidence in Younger vs Older People: A Systematic Review and Metaanalysis. JAMA Neurol. 2022 Oct 1;79(10):1036-1048. doi: 10.1001/jamaneurol.2022.1520.

5. Поляков Д.С., Фомин И.В., Беленков Ю.Н. и др. Хроническая сердечная недостаточность в Российской Федерации: что изменилось за 20 лет наблюдения? Результаты исследования ЭПОХАХСН. Кардиология. 2021;61(4):4-14. https://doi.org/10.18087/cardio.2021.4.n1628

6. Adelborg K, Szépligeti S, Sundbøll J et al. Risk of Stroke in Patients With Heart Failure: A Population-Based 30-Year Cohort Study. Stroke. 2017 May;48(5):1161-1168. doi: 10.1161/STROKEAHA.116.016022.

7. Tai YH, Chang CC, Yeh CC et al. Long-Term Risk of Stroke and Poststroke Outcomes in Patients with Heart Failure: Two Nationwide Studies. Clin Epidemiol. 2020 Nov 5;12:1235-1244. doi: 10.2147/CLEP.S261179.

8. Sartipy U, Dahlström U, Fu M et al. Atrial Fibrillation in Heart Failure With Preserved, Mid-Range, and Reduced Ejection Fraction. JACC Heart Fail. 2017 Aug;5(8):565-574. doi: 10.1016/j.jchf.2017.05.001.

9. Chen X, Savarese G, Dahlström U et al. Age-dependent differences in clinical phenotype and prognosis in heart failure with mid-range ejection compared with heart failure with reduced or preserved ejection fraction. Clin Res Cardiol. 2019 Dec;108(12):1394-1405. doi: 10.1007/s00392-019-01477-z.

10. Резник Е.В., Никитин И.Г. Кардиоренальный синдром у больных с сердечной недостаточностью как этап кардиоренального континуума (часть 2): прогностическое значение, профилактика и лечение. Архивъ внутренней медицины. 2019;9(2):93-106. https://doi.org/10.20514/2226-6704-2019-9-2-93-106

11. Alerić I, Katalinić D, Krpan M. Cardiopulmonary Interactions with Consecutive Pulmonary Abnormalities in Patients with Chronic Heart Failure. Acta Clin Croat. 2017 Sep;56(3):526-535. doi: 10.20471/acc.2017.56.03.20.

12. Столбова С.К., Драгомирецкая Н.А., Беляев Ю.Г. и др. Клинико-лабораторные ассоциации индексов печеночного фиброза у больных с декомпенсацией хронической сердечной недостаточности II–IV функциональных классов. Кардиология. 2020;60(5):90–99. https://doi.org/10.18087/cardio.2020.5.n920

13. Ерусланова К.А., Мхитарян Э.А., Изюмов А.Д. и др. Кардиоцеребральный синдром при хронической сердечной недостаточности. Российский неврологический журнал. 2022;27(1):26-30. https://doi.org/10.30629/2658-7947-2022-27-1-26-30

14. Scheitz JF, Sposato LA, Schulz-Menger J et al. Stroke-Heart Syndrome: Recent Advances and Challenges. J Am Heart Assoc. 2022 Sep 6; 11(17):e026528. doi: 10.1161/JAHA.122.026528.

15. Buckley BJR, Harrison SL, Hill A et al. Stroke-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications Following Stroke. Stroke. 2022 May;53(5):1759-1763. doi: 10.1161/STROKEAHA.121.037316.

16. Jung JM, Kim JG, Kim JB et al. Takotsubo-Like Myocardial Dysfunction in Ischemic Stroke: A Hospital-Based Registry and Systematic Literature Review. Stroke. 2016 Nov;47(11):2729-2736. doi: 10.1161/STROKEAHA.116.014304.

17. Byer E, Ashman R, Toth LA. Electrocardiograms with large, upright T waves and long Q-T intervals. Am Heart J. 1947 Jun;33(6):796-806. doi: 10.1016/0002-8703(47)90025-2.

18. Боголепов Н.К. Апоплектиформный синдром при инфаркте миокарда.1949. Клин мед.; 3: 36.

19. Боголепов Н.К. Церебральные кризы и инсульт. М 1971; 254-261

20. Scheitz JF, Nolte CH, Doehner W et al. Stroke-heart syndrome: clinical presentation and underlying mechanisms. Lancet Neurol. 2018 Dec;17(12):1109-1120. doi: 10.1016/S1474-4422(18)30336-3.

21. Mihalovic M, Tousek P. Myocardial Injury after Stroke. J Clin Med. 2021 Dec 21;11(1):2. doi: 10.3390/jcm11010002.

22. Ishiguchi H, Huang B, El-Bouri WK et al.; VISTA Collaborators †. Mortality Risk in Patients With Cardiac Complications Following Ischemic Stroke: A Report From the Virtual International Stroke Trials Archive. J Am Heart Assoc. 2024 Dec 3;13(23):e036799. doi: 10.1161/JAHA.124.036799.

23. Bucci T, Choi SE, Tsang CT et al. Incident dementia in ischaemic stroke patients with early cardiac complications: A propensityscore matched cohort study. Eur Stroke J. 2025 Jun;10(2):541-551. doi: 10.1177/23969873241293573.

24. Sposato LA, Hilz MJ, Aspberg S et al. World Stroke Organisation Brain & Heart Task Force. Post-Stroke Cardiovascular Complications and Neurogenic Cardiac Injury: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Dec 8;76(23):2768-2785. doi: 10.1016/j.jacc.2020.10.009.

25. Чаулин А.М., Карслян Л.С., Дупляков Д.В. Некоронарогенные причины повышения тропонинов в клинической практике. Клиническая практика. 2019;10(4):81–93. doi: 10.17816/clinpract16309

26. Broersen LHA, Stengl H, Nolte CH et al. Association Between HighSensitivity Cardiac Troponin and Risk of Stroke in 96 702 Individuals: A Meta-Analysis. Stroke. 2020 Apr;51(4):1085-1093. doi: 10.1161/STROKEAHA.119.028323.

27. Krause T, Werner K, Fiebach JB et al. Stroke in right dorsal anterior insular cortex Is related to myocardial injury. Ann Neurol. 2017 Apr;81(4):502-511. doi: 10.1002/ana.24906.

28. Scheitz JF, Lim J, Broersen LHA et al. High-Sensitivity Cardiac Troponin T and Recurrent Vascular Events After First Ischemic Stroke. J Am Heart Assoc. 2021 May 18;10(10):e018326. doi: 10.1161/JAHA.120.018326.

29. von Rennenberg R, Herm J, Krause T et al. Elevation of cardiac biomarkers in stroke is associated with pathological findings on cardiac MRI-results of the HEart and BRain interfaces in Acute Stroke study. Int J Stroke. 2023 Feb;18(2):180-186. doi: 10.1177/17474930221095698.

30. Nolte CH, von Rennenberg R, Litmeier S et al. Type 1 Myocardial Infarction in Patients With Acute Ischemic Stroke. JAMA Neurol. 2024 Jul 1;81(7):703-711. doi: 10.1001/jamaneurol.2024.1552.

31. Scheitz JF, Mochmann HC, Erdur H et al. Prognostic relevance of cardiac troponin T levels and their dynamic changes measured with a high-sensitivity assay in acute ischaemic stroke: analyses from the TRELAS cohort. Int J Cardiol. 2014 Dec 20;177(3):886-93. doi: 10.1016/j.ijcard.2014.10.036.

32. Prandin G, Caruso P, Furlanis G et al. Troponin levels in transient ischemic attack and ischemic stroke: does “transient” in your brain mean “better” for your heart? J Stroke Cerebrovasc Dis. 2024 Sep;33(9):107844. doi: 10.1016/j.jstrokecerebrovasdis.2024.107844.

33. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344-e418. doi: 10.1161/STR.0000000000000211.

34. Boulanger M, Béjot Y, Rothwell PM et al. Long-Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta-Analysis. J Am Heart Assoc. 2018 Jan 18;7(2):e007267. doi: 10.1161/JAHA.117.007267.

35. Sposato LA, Lam M, Allen B et al. First-ever ischemic stroke and increased risk of incident heart disease in older adults. Neurology. 2020 Apr 14;94(15):e1559-e1570. doi: 10.1212/WNL.0000000000009234.

36. Mitrică M, Lorusso L, Badea AA et al. The Hidden Heart: Exploring Cardiac Damage Post-Stroke: A Narrative Review. Medicina (Kaunas). 2024 Oct 16;60(10):1699. doi: 10.3390/medicina60101699.

37. Veltkamp R, Uhlmann S, Marinescu M et al. Experimental ischaemic stroke induces transient cardiac atrophy and dysfunction. J Cachexia Sarcopenia Muscle. 2019 Feb;10(1):54-62. doi: 10.1002/jcsm.12335.

38. Vornholz L, Nienhaus F, Gliem M et al. Acute Heart Failure After Reperfused Ischemic Stroke: Association With Systemic and Cardiac Inflammatory Responses. Front Physiol. 2021 Dec 21;12:782760. doi: 10.3389/fphys.2021.782760.

39. Bieber M, Werner RA, Tanai E et al. Stroke-induced chronic systolic dysfunction driven by sympathetic overactivity. Ann Neurol. 2017 Nov;82(5):729-743. doi: 10.1002/ana.25073.

40. Heuschmann PU, Montellano FA, Ungethüm K et al. Prevalence and determinants of systolic and diastolic cardiac dysfunction and heart failure in acute ischemic stroke patients: The SICFAIL study. ESC Heart Fail. 2021 Apr;8(2):1117-1129. doi: 10.1002/ehf2.13145.

41. Hassan MS, Mire Waberi M, Osman Sidow N et al. Analysis of Echocardiographic Findings of Patients with Acute Ischemic Stroke Admitted to a Tertiary Care Hospital in Mogadishu, Somalia. Int J Gen Med. 2023 Jul 7;16:2887-2895. doi: 10.2147/IJGM.S414014.

42. Park HK, Kim BJ, Yoon CH et al. Left Ventricular Diastolic Dysfunction in Ischemic Stroke: Functional and Vascular Outcomes. J Stroke. 2016 May;18(2):195-202. doi: 10.5853/jos.2015.01697.

43. Xu C, Zheng A, He T et al. Brain-Heart Axis and Biomarkers of Cardiac Damage and Dysfunction after Stroke: A Systematic Review and Meta-Analysis. Int J Mol Sci. 2020 Mar 28;21(7):2347. doi: 10.3390/ijms21072347.

44. Hermanns N, Wroblewski V, Bascuñana P et al. Molecular imaging of the brain-heart axis provides insights into cardiac dysfunction after cerebral ischemia. Basic Res Cardiol. 2022 Oct 24;117(1):52. doi: 10.1007/s00395-022-00961-4.

45. Dieplinger B, Bocksrucker C, Egger M et al. Prognostic Value of Inflammatory and Cardiovascular Biomarkers for Prediction of 90- Day All-Cause Mortality after Acute Ischemic Stroke-Results from the Linz Stroke Unit Study. Clin Chem. 2017 Jun;63(6):1101-1109. doi: 10.1373/clinchem.2016.269969.

46. Patel U, Desai R, Faisaluddin M et al. Prevalence and impact of takotsubo syndrome in hospitalizations for acute ischemic stroke. Proc (Bayl Univ Med Cent). 2021 Nov 9;35(2):156-161. doi: 10.1080/08998280.2021.1995932.

47. Jung JM, Kim JG, Kim JB et al.Takotsubo-Like Myocardial Dysfunction in Ischemic Stroke: A Hospital-Based Registry and Systematic Literature Review. Stroke. 2016 Nov;47(11):2729-2736. doi: 10.1161/STROKEAHA.116.014304.

48. Ghadri JR, Kato K, Cammann VL et al. Long-Term Prognosis of Patients With Takotsubo Syndrome. J Am Coll Cardiol. 2018 Aug 21;72(8):874-882. doi: 10.1016/j.jacc.2018.06.016.

49. Pelliccia F, Kaski JC, Crea F et al. Pathophysiology of Takotsubo Syndrome. Circulation. 2017 Jun 13;135(24):2426-2441. doi: 10.1161/CIRCULATIONAHA.116.027121.

50. Wittstein IS, Thiemann DR, Lima JA et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005 Feb 10;352(6):539-48. doi: 10.1056/NEJMoa043046. PMID: 15703419.

51. Yoshimura S, Toyoda K, Ohara T et al. Takotsubo cardiomyopathy in acute ischemic stroke. Ann Neurol. 2008 Nov;64(5):547-54. doi: 10.1002/ana.21459.

52. Zeng Z, Wang Q, Yu Y et al. Assessing electrocardiogram changes after ischemic stroke with artificial intelligence. PLoS One. 2022 Dec 27;17(12):e0279706. doi: 10.1371/journal.pone.0279706.

53. Daniele O, Caravaglios G, Fierro B et al. Stroke and cardiac arrhythmias. J Stroke Cerebrovasc Dis. 2002 Jan-Feb;11(1):28-33. doi: 10.1053/jscd.2002.123972.

54. Ishiguchi H, Huang B, El-Bouri WK et al. VISTA Collaborators †. Mortality Risk in Patients With Cardiac Complications Following Ischemic Stroke: A Report From the Virtual International Stroke Trials Archive. J Am Heart Assoc. 2024 Dec 3;13(23):e036799. doi: 10.1161/JAHA.124.036799.

55. Hjalmarsson C, Bokemark L, Fredriksson S et al. Can prolonged QTc and cTNT level predict the acute and long-term prognosis of stroke? Int J Cardiol. 2012 Mar 22;155(3):414-7. doi: 10.1016/j.ijcard.2010.10.042.

56. Christensen H, Fogh Christensen A, Boysen G. Abnormalities on ECG and telemetry predict stroke outcome at 3 months. J Neurol Sci. 2005 Jul 15;234(1-2):99-103. doi: 10.1016/j.jns.2005.03.039.

57. Kallmünzer B, Breuer L, Kahl N et al. Serious cardiac arrhythmias after stroke: incidence, time course, and predictors--a systematic, prospective analysis. Stroke. 2012 Nov;43(11):2892-7. doi: 10.1161/STROKEAHA.112.664318.

58. Garnier L, Duloquin G, Meloux A et al. Multimodal Approach for the Prediction of Atrial Fibrillation Detected After Stroke: SAFAS Study. Front Cardiovasc Med. 2022 Jul 13;9:949213. doi: 10.3389/fcvm.2022.949213.

59. Cerasuolo JO, Cipriano LE, Sposato LA. The complexity of atrial fibrillation newly diagnosed after ischemic stroke and transient ischemic attack: advances and uncertainties. Curr Opin Neurol. 2017 Feb;30(1):28-37. doi: 10.1097/WCO.0000000000000410.

60. Sposato LA, Cerasuolo JO, Cipriano LE et al. PARADISE Study Group. Atrial fibrillation detected after stroke is related to a low risk of ischemic stroke recurrence. Neurology. 2018 Mar 13;90(11):e924-e931. doi: 10.1212/WNL.0000000000005126.

61. Fridman S, Jimenez-Ruiz A, Vargas-Gonzalez JC et al. Differences between Atrial Fibrillation Detected before and after Stroke and TIA: A Systematic Review and Meta-Analysis. Cerebrovasc Dis. 2022;51(2):152-157. doi: 10.1159/000520101.

62. Min J, Young G, Umar A et al. Neurogenic cardiac outcome in patients after acute ischemic stroke: The brain and heart connection. J Stroke Cerebrovasc Dis. 2022 Dec;31(12):106859. doi: 10.1016/j.jstrokecerebrovasdis.2022.106859.

63. Sposato LA, Hilz MJ, Aspberg S et al.; World Stroke Organisation Brain & Heart Task Force. Post-Stroke Cardiovascular Complications and Neurogenic Cardiac Injury: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Dec 8;76(23):2768-2785. doi: 10.1016/j.jacc.2020.10.009.

64. Fan X, Cao J, Li M et al. Stroke Related Brain-Heart Crosstalk: Pathophysiology, Clinical Implications, and Underlying Mechanisms. Adv Sci (Weinh). 2024 Apr;11(14):e2307698. doi: 10.1002/advs.202307698.

65. Poh MQW, Tham CH, Chee JDMS et al. Predicting Atrial Fibrillation after Ischemic Stroke: Clinical, Genetics, and Electrocardiogram Modelling. Cerebrovasc Dis Extra. 2023;13(1):9-17. doi: 10.1159/000528516.

66. Pang M, Li Z, Sun L et al. A nomogram for predicting atrial fibrillation detected after acute ischemic stroke. Front Neurol. 2022 Oct 14;13:1005885. doi: 10.3389/fneur.2022.1005885.

67. Deng G, Chu YH, Xiao J et al. Risk Factors, Pathophysiologic Mechanisms, and Potential Treatment Strategies of Futile Recanalization after Endovascular Therapy in Acute Ischemic Stroke. Aging Dis. 2023 Dec 1;14(6):2096-2112. doi: 10.14336/AD.2023.0321-1.

68. Wang W, Wang M, Ma C et al. Transcutaneous auricular vagus nerve stimulation attenuates stroke-heart syndrome: The role of parasympathetic activity. Exp Neurol. 2025 Mar;385:115094. doi: 10.1016/j.expneurol.2024.115094.

69. Ghadri JR, Wittstein IS, Prasad A et al. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology. Eur Heart J. 2018 Jun 7;39(22):2032-2046. doi: 10.1093/eurheartj/ehy076.

70. Saini G, Kaur K, Bhatia L et al. Single Serum Cortisol Value as a Prognostic Marker in Acute Ischemic Stroke. Cureus. 2023 Jun 24; 15(6):e40887. doi: 10.7759/cureus.40887.

71. Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. 2020 Jul;18(7):1559-1561. doi: 10.1111/jth.14849.

72. Dhanesha N, Patel RB, Doddapattar P et al. PKM2 promotes neutrophil activation and cerebral thromboinflammation: therapeutic implications for ischemic stroke. Blood. 2022 Feb 24;139(8):1234-1245. doi: 10.1182/blood.2021012322.

73. Kim M, Kim SD, Kim KI et al. Dynamics of T Lymphocyte between the Periphery and the Brain from the Acute to the Chronic Phase Following Ischemic Stroke in Mice. Exp Neurobiol. 2021 Apr 30; 30(2):155-169. doi: 10.5607/en20062.

74. Yan T, Chen Z, Chopp M et al. Inflammatory responses mediate brain-heart interaction after ischemic stroke in adult mice. J Cereb Blood Flow Metab. 2020 Jun;40(6):1213-1229. doi: 10.1177/0271678X18813317.

75. Wang M, Peng Y. Advances in brain-heart syndrome: Attention to cardiac complications after ischemic stroke. Front Mol Neurosci. 2022 Nov 24;15:1053478. doi: 10.3389/fnmol.2022.1053478.

76. Fest J, Ruiter R, Mulder M et al. The systemic immune-inflammation index is associated with an increased risk of incident cancer-A population-based cohort study. Int J Cancer. 2020 Feb 1;146(3):692-698. doi: 10.1002/ijc.32303.

77. Hao X, Zhu M, Sun Z et al. Systemic immune-inflammation index is associated with cardiac complications following acute ischemic stroke: A retrospective single-center study. Clin Neurol Neurosurg. 2024 Jun;241:108285. doi: 10.1016/j.clineuro.2024.108285.

78. Weng Y, Zeng T, Huang H et al. Systemic Immune-Inflammation Index Predicts 3-Month Functional Outcome in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis. Clin Interv Aging. 2021 May 20;16:877-886. doi: 10.2147/CIA.S311047.

79. Chen J, Cui C, Yang X et al. MiR-126 Affects Brain-Heart Interaction after Cerebral Ischemic Stroke. Transl Stroke Res. 2017 Aug;8(4):374-385. doi: 10.1007/s12975-017-0520-z.

80. Wang M, Peng Y. Advances in brain-heart syndrome: Attention to cardiac complications after ischemic stroke. Front Mol Neurosci. 2022 Nov 24;15:1053478. doi: 10.3389/fnmol.2022.1053478.

81. Wang S, Aurora AB, Johnson BA et al. The endothelial-specific microRNA miR-126 governs vascular integrity and angiogenesis. Dev Cell. 2008 Aug;15(2):261-71. doi: 10.1016/j.devcel.2008.07.002.

82. Ishiguchi H, Huang B, El-Bouri WK et al. Stroke-heart syndrome and early mortality in patients with acute ischaemic stroke using hierarchical cluster analysis: An individual patient data pooled analysis from the VISTA database. Eur Stroke J. 2025 Jun;10(2):478-486. doi: 10.1 177/23969873241290440.