Stroke-Heart Syndrome: Mechanisms, Temporal Phenotypes, and Diagnostic Reasoning.
10 affiliations
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
- 2China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.
- 3Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China.
- 4NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Beijing, People's Republic of China.
- 5China National Clinical Research Center for Chinese Medicine Cardiology, Beijing, People's Republic of China.
- 6Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
- 7Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
- 8Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital, Beijing, People's Republic of China.
- 9Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.
- 10Affiliated Hospital of Hebei University, Baoding, Hebei, People's Republic of China.
Abstract
Stroke-heart syndrome (SHS) encompasses new or worsened cardiac abnormalities that arise after acute stroke, most often within the first 30 days and with an early peak. Its spectrum includes acute myocardial injury, electrocardiographic changes, arrhythmia, ventricular dysfunction, Takotsubo syndrome, and heart failure, but similar findings may reflect antecedent cardiac disease or systemic illness. This Review defines the accepted clinical boundaries of SHS and integrates central autonomic network disruption, neuroendocrine stress, inflammation, endothelial and microvascular dysfunction, oxygen supply-demand imbalance, and premorbid substrate into a time-resolved framework. Eight provisional, non-mutually-exclusive phenotypic domains are proposed to organize current evidence without implying validated endotypes. A diagnostic approach based on symptom chronology, prior cardiac data, serial troponin and electrocardiography, rhythm monitoring, echocardiography, selective coronary assessment, and cardiac magnetic resonance is presented to distinguish stroke-triggered injury from recent myocardial infarction, pre-existing atrial fibrillation, chronic myocardial injury, and established heart failure. No syndrome-specific treatment is validated; care should prioritize recognized cardiac emergencies, correction of reversible stressors, and coordinated stroke-cardiology decision-making. Prospective studies with documented premorbid status, standardized time points, and blinded adjudication are needed to validate the proposed phenotypes and determine whether they improve outcomes.
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BibTeX
@article{lin2026strokeheart,
title = {{Stroke-Heart Syndrome: Mechanisms, Temporal Phenotypes, and Diagnostic Reasoning.}},
author = {Fa Lin and Jian Lyu and Yanci Liu and Zhiyuan Feng and Jie Bao and Wenxiong Song and Bingcheng Zhu and Minghao Liu and Jionghao Xue and Jiadi Weng and Jiani Zhang and Jizong Zhao and Xiaolin Chen and Bin Dong},
journal = {Advanced science (Weinheim, Baden-Wurttemberg, Germany)},
year = {2026},
month = oct,
doi = {10.1002/advs.78548},
url = {https://europepmc.org/article/MED/42952156},
note = {CC BY},
}
RIS
TY - JOUR
TI - Stroke-Heart Syndrome: Mechanisms, Temporal Phenotypes, and Diagnostic Reasoning.
AU - Fa Lin
AU - Jian Lyu
AU - Yanci Liu
AU - Zhiyuan Feng
AU - Jie Bao
AU - Wenxiong Song
AU - Bingcheng Zhu
AU - Minghao Liu
AU - Jionghao Xue
AU - Jiadi Weng
AU - Jiani Zhang
AU - Jizong Zhao
AU - Xiaolin Chen
AU - Bin Dong
PY - 2026
DA - 2026/10/28
JO - Advanced science (Weinheim, Baden-Wurttemberg, Germany)
DO - 10.1002/advs.78548
UR - https://europepmc.org/article/MED/42952156
AB - Stroke-heart syndrome (SHS) encompasses new or worsened cardiac abnormalities that arise after acute stroke, most often within the first 30 days and with an early peak. Its spectrum includes acute myocardial injury, electrocardiographic changes, arrhythmia, ventricular dysfunction, Takotsubo syndrome, and heart failure, but similar findings may reflect antecedent cardiac disease or systemic illness. This Review defines the accepted clinical boundaries of SHS and integrates central autonomic network disruption, neuroendocrine stress, inflammation, endothelial and microvascular dysfunction, oxygen supply-demand imbalance, and premorbid substrate into a time-resolved framework. Eight provisional, non-mutually-exclusive phenotypic domains are proposed to organize current evidence without implying validated endotypes. A diagnostic approach based on symptom chronology, prior cardiac data, serial troponin and electrocardiography, rhythm monitoring, echocardiography, selective coronary assessment, and cardiac magnetic resonance is presented to distinguish stroke-triggered injury from recent myocardial infarction, pre-existing atrial fibrillation, chronic myocardial injury, and established heart failure. No syndrome-specific treatment is validated; care should prioritize recognized cardiac emergencies, correction of reversible stressors, and coordinated stroke-cardiology decision-making. Prospective studies with documented premorbid status, standardized time points, and blinded adjudication are needed to validate the proposed phenotypes and determine whether they improve outcomes.
SN - 2198-3844
ER -