Der Nervenarzt

, Volume 82, Issue 6, pp 733–742 | Cite as

Neurologische Aspekte bei chronischer Herzinsuffizienz

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Zusammenfassung

Die chronische Herzinsuffizienz (CHI) gehört zu den häufigsten internistischen Erkrankungen und ist mit einer hohen Morbidität und Letalität assoziiert. Patienten mit CHI weisen eine hohe neurologische Komorbidität mit einem erhöhten Risiko für ischämische Hirninfarkte, kognitive Defizite, degenerative Veränderungen des zentralen Nervensystems und ein Schlafapnoesyndrom auf. Das relative Schlaganfallrisiko ist bei bestehender Herzinsuffizienz (HI) etwa 2- bis 3fach erhöht und nimmt mit zunehmendem Alter, bei arterieller Hypertonie und insbesondere bei begleitendem Vorhofflimmern zu. Darüber hinaus ist bei HI die schlaganfallassoziierte Sterblichkeit und das Risiko für eine persistierende schwere Behinderung mehr als verdoppelt. Bei 25–80% der CHI-Patienten werden zudem kognitive Defizite beschrieben, welche durch Aufmerksamkeits-, Merkfähigkeits- und Konzentrationsstörungen, eine verminderte psychomotorische Geschwindigkeit und exekutive Funktionsstörungen charakterisiert sind. Als mögliche Ursachen werden die bei CHI nachgewiesene kortikale Atrophie, die verminderte zerebrale Perfusion, eine gestörte zerebrale Autoregulation und ischämische Hirninfarkte angesehen. Das Risiko für eine Demenz ist bei CHI in etwa verdoppelt. Zudem ist von einer erhöhten Letalität bei kognitiven Defiziten auszugehen. Ebenso mit einer schlechten Prognose assoziiert ist das bei weit über der Hälfte aller Patienten mit reduzierter Ejektionsfraktion (EF) nachweisbare, zumeist zentral bedingte Schlafapnoesyndrom. Prospektive klinische Studien müssen allerdings erst nachweisen, ob eine frühzeitige und optimierte Therapie der CHI die assoziierten neurologischen und neuropsychologischen Folgeschäden tatsächlich reduzieren kann.

Schlüsselwörter

Herzinsuffizienz Komorbidität Schlaganfall Kortikale Atrophie Demenz 

Neurological aspects of chronic heart failure

Summary

Chronic heart failure (CHF) is one of the leading causes of hospitalization, morbidity and mortality. Moreover, there is a high rate of neurological as well as neuropsychological comorbidities, namely ischemic stroke, structural brain alterations, cognitive impairment, sleep apnea and possible side-effects of HF medication such as delirium or (intracerebral) hemorrhage. The higher stroke risk in patients with HF increases further with age, concomitant arterial hypertension or atrial fibrillation (AF). In women the stroke risk increases with reduced ejection fraction (EF). In general stroke in HF patients is associated with a poor outcome and higher mortality, which is increased more than 2-fold. Furthermore, approximately 25-80% of all patients with CHF experience cognitive impairments such as decreased attention and concentration, memory loss, diminished psychomotor reaction time and decreased executive functions. Cognitive impairment in patients with HF has been linked to losses in gray matter, (silent) ischemic strokes, decreased cerebral perfusion and higher mortality. Moreover, sleep apnea occurs in more than half of all patients with CHF and reduced EF. However, prospective studies are needed to test whether early detection and optimal treatment of HF reduces the burden of neurological and neuropsychological sequelae.

Keywords

Heart failure Comorbidity Stroke Cortical atrophy Dementia 
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Notes

Danksagung

Die Autoren erhalten Forschungsförderung vom Bundesministerium für Bildung und Forschung (Centrum für Schlaganfallforschung Berlin, ME, KGH), vom European Stroke Network (ME, UL), der Volkswagen Stiftung (Lichtenberg-Programm, ME) sowie der Deutschen Forschungsgemeinschaft (SFB TR43, ME).

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Klinik und Poliklinik für NeurologieCharité-Universitätsmedizin Berlin, Campus Benjamin FranklinBerlinDeutschland
  2. 2.Centrum für Schlaganfallforschung BerlinBerlinDeutschland
  3. 3.Klinik für Innere Medizin IIIUniversität des SaarlandesHomburg/SaarDeutschland

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