脑卒中供者心脏的心肌损伤机制与临床研究进展

doi:10.3969/j.issn.1674-7445.2023.01.005

脑卒中供者心脏的心肌损伤机制与临床研究进展

doi: 10.3969/j.issn.1674-7445.2023.01.005

400016 重庆，重庆医科大学附属第一医院心胸外科（王小文）；中国医学科学院阜外医院心脏外科（王小文、郑哲），心力衰竭与移植病房（黄洁）

基金项目:

国家重点研发计划项目 2016YFC1300900

创新工程-中国医学科学院临床与转化医学研究专项 2022-I2M-C & T-B-038

详细信息

作者简介:

通讯作者:
郑哲，Email：zhengzhe@fuwai.com

黄洁，Email：huangjie@fuwai.com

中图分类号: R617, R722.15+1, R541
计量
- 文章访问数: 100
- HTML全文浏览量: 44
- PDF下载量: 12
- 被引次数: 0
出版历程
- 收稿日期: 2022-11-03
- 网络出版日期: 2023-01-17
- 刊出日期: 2023-01-15

Clinical research progress and mechanism on myocardial injury in hearts from donors with stroke

Department of Cardiothoracic Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

More Information

Corresponding author: Zheng Zhe, Email: zhengzhe@fuwai.com; Huang Jie, Email: huangjie@fuwai.com

摘要

摘要: 脑死亡供者心脏是目前心脏移植最主要的器官来源。脑死亡发生后会出现严重的血流动力学改变和一系列器官功能变化，进而造成组织器官的功能损害甚至丧失，尤其是心脏。神经系统和心血管系统的生理、病理生理之间存在密切联系和相互作用，脑卒中发生后，通过脑-心轴反应导致自主神经失调、神经内分泌紊乱和强烈而持续的炎症反应，引发交感风暴、儿茶酚胺风暴、炎症风暴等导致脑卒中所致心脏损伤。本文旨在对近年来有关脑卒中供者心脏心肌损伤的机制研究及其对心脏移植术后疗效和预后影响的相关研究进行综述，为临床实践和进一步研究提供参考。
- 脑卒中 /
- 心脏移植 /
- 脑死亡 /
- 冠状动脉粥样硬化性心病 /
- 心律失常 /
- 交感风暴 /
- 儿茶酚胺风暴
Abstract: At present, the heart of donor from donation after brain death are the primary organ sources for heart transplantation. After brain death, severe hemodynamic changes and a series of organ functional changes will occur, thereby leading to the functional damage or even loss of tissues and organs, especially the heart. Intimate relationship and interaction have been found in the physiology and pathophysiology between nervous and cardiovascular systems. After stroke, autonomic nervous disorder, neuroendocrine disorder and intense and persistent inflammatory reaction could be caused by the brain-heart axis reaction, leading to stroke-induced cardiac injuries, such as sympathetic storm, catecholamine storm, inflammatory storm, etc. In this article, research progresses on the mechanism of myocardial injury in heart from donors with stroke and the effect on clinical efficacy and prognosis after heart transplantation were reviewed, aiming to provide reference for clinical practice and subsequent research.
- Stroke /
- Heart transplantation /
- Brain death /
- Coronary atherosclerotic heart disease /
- Arrhythmia /
- Sympathetic storm /
- Catecholamine storm

HTML全文

下载: 全尺寸图片幻灯片

参考文献(47)

[1]	SCHEITZ JF, NOLTE CH, DOEHNER W, et al. Stroke-heart syndrome: clinical presentation and underlying mechanisms[J]. Lancet Neurol, 2018, 17(12): 1109-1120. DOI: 10.1016/S1474-4422(18)30336-3.
[2]	SPOSATO LA, HILZ MJ, ASPBERG S, et al. Post-stroke cardiovascular complications and neurogenic cardiac injury: JACC state-of-the-art review[J]. J Am Coll Cardiol, 2020, 76(23): 2768-2785. DOI: 10.1016/j.jacc.2020.10.009.
[3]	BUCKLEY BJR, HARRISON SL, HILL A, et al. Stroke-heart syndrome: incidence and clinical outcomes of cardiac complications following stroke[J]. Stroke, 2022, 53(5): 1759-1763. DOI: 10.1161/STROKEAHA.121.037316.
[4]	BALINT B, JAREMEK V, THORBURN V, et al. Left atrial microvascular endothelial dysfunction, myocardial inflammation and fibrosis after selective insular cortex ischemic stroke[J]. Int J Cardiol, 2019, 292: 148-155. DOI: 10.1016/j.ijcard.2019.06.004.
[5]	MELOUX A, RIGAL E, ROCHETTE L, et al. Ischemic stroke increases heart vulnerability to ischemia-reperfusion and alters myocardial cardioprotective pathways[J]. Stroke, 2018, 49(11): 2752-2760. DOI: 10.1161/STROKEAHA.118.022207.
[6]	ZHOU Y, ZHANG Y, CUI M, et al. Prognostic value of the systemic inflammation response index in patients with acute ischemic stroke[J]. Brain Behav, 2022, 12(6): e2619. DOI: 10.1002/brb3.2619.
[7]	COURTIES G, FRODERMANN V, HONOLD L, et al. Glucocorticoids regulate bone marrow B lymphopoiesis after stroke[J]. Circ Res, 2019, 124(9): 1372-1385. DOI: 10.1161/CIRCRESAHA.118.314518.
[8]	ZHANG X, LEI B, YUAN Y, et al. Brain control of humoral immune responses amenable to behavioural modulation[J]. Nature, 2020, 581(7807): 204-208. DOI: 10.1038/s41586-020-2235-7.
[9]	DING Y, DEGRACIA D, GENG X, et al. Perspectives on effect of spleen in ischemic stroke[J]. Brain Circ, 2022, 8(3): 117-120. DOI: 10.4103/bc.bc_53_22.
[10]	STEPHENS R, GRAINGER JR, SMITH CJ, et al. Systemic innate myeloid responses to acute ischaemic and haemorrhagic stroke[J]. Semin Immunopathol, 2022, DOI: 10.1007/s00281-022-00968-y[Epub ahead of print].
[11]	CANDELARIO-JALIL E, DIJKHUIZEN RM, MAGNUS T. Neuroinflammation, stroke, blood-brain barrier dysfunction, and imaging modalities[J]. Stroke, 2022, 53(5): 1473-1486. DOI: 10.1161/STROKEAHA.122.036946.
[12]	VORNHOLZ L, NIENHAUS F, GLIEM M, et al. Acute heart failure after reperfused ischemic stroke: association with systemic and cardiac inflammatory responses[J]. Front Physiol, 2021, 12: 782760. DOI: 10.3389/fphys.2021.782760.
[13]	YAN T, CHEN Z, CHOPP M, et al. Inflammatory responses mediate brain-heart interaction after ischemic stroke in adult mice[J]. J Cereb Blood Flow Metab, 2020, 40(6): 1213-1229. DOI: 10.1177/0271678X18813317.
[14]	DU Y, DEMILLARD LJ, REN J. Catecholamine-induced cardiotoxicity: a critical element in the pathophysiology of stroke-induced heart injury[J]. Life Sci, 2021, 287: 120106. DOI: 10.1016/j.lfs.2021.120106.
[15]	SHI K, TIAN DC, LI ZG, et al. Global brain inflammation in stroke[J]. Lancet Neurol, 2019, 18(11): 1058-1066. DOI: 10.1016/S1474-4422(19)30078-X.
[16]	MO Y, SUN YY, LIU KY. Autophagy and inflammation in ischemic stroke[J]. Neural Regen Res, 2020, 15(8): 1388-1396. DOI: 10.4103/1673-5374.274331.
[17]	ISHIKAWA H, TAJIRI N, VASCONCELLOS J, et al. Ischemic stroke brain sends indirect cell death signals to the heart[J]. Stroke, 2013, 44(11): 3175-3182. DOI: 10.1161/STROKEAHA.113.001714.
[18]	AKSU T, GOPINATHANNAIR R, GUPTA D, et al. Intrinsic cardiac autonomic nervous system: what do clinical electrophysiologists need to know about the "heart brain"?[J]. J Cardiovasc Electrophysiol, 2021, 32(6): 1737-1747. DOI: 10.1111/jce.15058.
[19]	BIEBER M, WERNER RA, TANAI E, et al. Stroke-induced chronic systolic dysfunction driven by sympathetic overactivity[J]. Ann Neurol, 2017, 82(5): 729-743. DOI: 10.1002/ana.25073.
[20]	SCHWARZ K, AHEARN T, SRINIVASAN J, et al. Alterations in cardiac deformation, timing of contraction and relaxation, and early myocardial fibrosis accompany the apparent recovery of acute stress-induced (Takotsubo) cardiomyopathy: an end to the concept of transience[J]. J Am Soc Echocardiogr, 2017, 30(8): 745-755. DOI: 10.1016/j.echo.2017.03.016.
[21]	YANG D, DAI X, XING Y, et al. Intrinsic cardiac adrenergic cells contribute to LPS-induced myocardial dysfunction[J]. Commun Biol, 2022, 5(1): 96. DOI: 10.1038/s42003-022-03007-6.
[22]	CEREUIL A, RONFLÉ R, CULVER A, et al. Septic shock: phenotypes and outcomes[J]. Adv Ther, 2022, 39(11): 5058-5071. DOI: 10.1007/s12325-022-02280-5.
[23]	SPOSATO LA, LAM M, ALLEN B, et al. First-ever ischemic stroke and increased risk of incident heart disease in older adults[J]. Neurology, 2020, 94(15): e1559-e1570. DOI: 10.1212/WNL.0000000000009234.
[24]	PUTAALA J, LEHTO M, MERETOJA A, et al. In-hospital cardiac complications after intracerebral hemorrhage[J]. Int J Stroke, 2014, 9(6): 741-746. DOI: 10.1111/ijs.12180.
[25]	AHMADIAN A, MIZZI A, BANASIAK M, et al. Cardiac manifestations of subarachnoid hemorrhage[J]. Heart Lung Vessel, 2013, 5(3): 168-178.
[26]	DOSHI R, NEIL-DWYER G. A clinicopathological study of patients following a subarachnoid hemorrhage[J]. J Neurosurg, 1980, 52(3): 295-301. DOI: 10.3171/jns.1980.52.3.0295.
[27]	LETTOW I, JENSEN M, SCHLEMM E, et al. Serious adverse events and their impact on functional outcome in acute ischemic stroke in the WAKE-UP trial[J]. Stroke, 2021, 52(12): 3768-3776. DOI: 10.1161/STROKEAHA.120.033425.
[28]	SCHEITZ JF, SPOSATO LA, SCHULZ-MENGER J, et al. Stroke-heart syndrome: recent advances and challenges[J]. J Am Heart Assoc, 2022, 11(17): e026528. DOI: 10.1161/JAHA.122.026528.
[29]	STENGL H, GANESHAN R, HELLWIG S, et al. Cardiomyocyte injury following acute ischemic stroke: protocol for a prospective observational cohort study[J]. JMIR Res Protoc, 2021, 10(2): e24186. DOI: 10.2196/24186.
[30]	SIMATS A, LIESZ A. Systemic inflammation after stroke: implications for post-stroke comorbidities[J]. EMBO Mol Med, 2022, 14(9): e16269. DOI: 10.15252/emmm.202216269.
[31]	VENKAT P, CUI C, CHEN Z, et al. CD133+exosome treatment improves cardiac function after stroke in type 2 diabetic mice[J]. Transl Stroke Res, 2021, 12(1): 112-124. DOI: 10.1007/s12975-020-00807-y.
[32]	SIEDLER G, SOMMER K, MACHA K, et al. Heart failure in ischemic stroke: relevance for acute care and outcome[J]. Stroke, 2019, 50(11): 3051-3056. DOI: 10.1161/STROKEAHA.119.026139.
[33]	JAPUNDŽIĆ-ŽIGON N, ŠARENAC O, LOZIĆ M, et al. Sudden death: neurogenic causes, prediction and prevention[J]. Eur J Prev Cardiol, 2018, 25(1): 29-39. DOI: 10.1177/2047487317736827.
[34]	KIM AS, MOFFATT E, URSELL PC, et al. Sudden neurologic death masquerading as out-of-hospital sudden cardiac death[J]. Neurology, 2016, 87(16): 1669-1673. DOI: 10.1212/WNL.0000000000003238.
[35]	HINTERDOBLER J, SCHOTT S, JIN H, et al. Acute mental stress drives vascular inflammation and promotes plaque destabilization in mouse atherosclerosis[J]. Eur Heart J, 2021, 42(39): 4077-4088. DOI: 10.1093/eurheartj/ehab371.
[36]	BILGE S, TEZEL O, ACAR YA, et al. Investigation of the value of T peak to T end and QTc intervals as electrocardiographic arrhythmia susceptibility markers in acute ischemic stroke[J]. Noro Psikiyatr Ars, 2020, 57(3): 171-176. DOI: 10.29399/npa.24996.
[37]	DANIELE O, CARAVAGLIOS G, FIERRO B, et al. Stroke and cardiac arrhythmias[J]. J Stroke Cerebrovasc Dis, 2002, 11(1): 28-33. DOI: 10.1053/jscd.2002.123972.
[38]	WILHELM MJ, PRATSCHKE J, BEATO F, et al. Activation of the heart by donor brain death accelerates acute rejection after transplantation[J]. Circulation, 2000, 102(19): 2426-2433. DOI: 10.1161/01.cir.102.19.2426.
[39]	KHUSH KK, POTENA L, CHERIKH WS, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: 37th adult heart transplantation report-2020; focus on deceased donor characteristics[J]. J Heart Lung Transplant, 2020, 39(10): 1003-1015. DOI: 10.1016/j.healun.2020.07.010.
[40]	OEHLER D, IMMOHR MB, ERBEL-KHURTSIDZE S, et al. Intracerebral bleeding in donors is associated with reduced short-term to midterm survival of heart transplant recipients[J]. ESC Heart Fail, 2022, 9(4): 2419-2427. DOI: 10.1002/ehf2.13935.
[41]	MIKAMI T, ITAGAKI S, FUJISAKI T, et al. Association of donor brain death due to stroke with prognosis after heart transplantation[J]. J Am Coll Cardiol, 2022, 79(11): 1063-1072. DOI: 10.1016/j.jacc.2021.12.031.
[42]	KRISHNAMURTHI RV, FEIGIN VL, FOROUZANFAR MH, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010[J]. Lancet Glob Health, 2013, 1(5): e259-e281. DOI: 10.1016/S2214-109X(13)70089-5.
[43]	JO YJ, KIM DH, SOHN MK, et al. Clinical characteristics and risk factors of first-ever stroke in young adults: a multicenter, prospective cohort study[J]. J Pers Med, 2022, 12(9): 1505. DOI: 10.3390/jpm12091505.
[44]	CHO BH, KIM JH, SUH SH, et al. Characteristics of intracranial aneurysms according to levels of coronary artery calcium[J]. Stroke, 2019, 50(6): 1403-1408. DOI: 10.1161/STROKEAHA.119.024726.
[45]	RIVINIUS R, HELMSCHROTT M, RUHPARWAR A, et al. Elevated pre-transplant pulmonary vascular resistance is associated with early post-transplant atrial fibrillation and mortality[J]. ESC Heart Fail, 2020, 7(1): 176-187. DOI: 10.1002/ehf2.12549.
[46]	VAN TRIGT P, BITTNER HB, KENDALL SW, et al. Mechanisms of transplant right ventricular dysfunction[J]. Ann Surg, 1995, 221(6): 666-675. DOI: 10.1097/00000658-199506000-00006.
[47]	SZABÓ G, SEBENING C, HAGL C, et al. Right ventricular function after brain death: response to an increased afterload[J]. Eur J Cardiothorac Surg, 1998, 13(4): 449-458. DOI: 10.1016/s1010-7940(98)00049-9.