The brain in heart failure

After atrial fibrillation, heart failure is the second most frequent cardiac association of stroke. Deteriorating left ventricular systolic function appears to increase the risk of cardioembolic stroke in heart failure. Age, hypertension and prior stroke are also risk factors for stroke in heart failure. Since these are risk factors for cerebral and other vascular disease rather than for cardioembolism, embolism may not be the sole pathogenesis of stroke in heart failure. Hypoperfusion as a cause of cerebral injury is suggested by a reduction of blood flow and autoregulatory capacity in severe heart failure. An increase in cerebral infarct volume and impaired cognition in patients with left ventricular systolic dysfunction also supports this. There is a need for further research to define how the brain is affected by progressive cardiac failure and to determine which echocardiographic and other vascular risk factors best indicate an increased stroke risk