Stroke is the second most common cause of death (after ischaemic heart disease) and the leading cause of disability in adult life with often devastating impact on the patients and their families. As such it represents tremendous social and economic burden to the society.
Stroke is a vascular disease, in fact, it should be viewed as cardiovascular disease, given the strong interaction with cardiac pathologies. Importantly, cardiac diseases and cardiovascular risk factors not only increase the risk of stroke, the pathophysiological interaction of the heart and the brain works as much in the opposite direction, too: a stroke can have a detrimental impact on both function and structure of the heart (Figure 1, see p M3–M12, Doehner et al.).1
Figure 1.
The heart–stroke interaction. Adapted from Doehner et al., Eur J Prevent Cardiol 2020; 682–692.
There is no doubt that cardiologic expertise is very much needed in contemporary stroke care
Cardiologists should broaden their insight and access to all aspects of stroke from prevention to acute therapy and to post-stroke rehabilitation and secondary prevention. This Focus issue of EHJ supplements provides an overview on a range of relevant stroke topics that are clearly in the domain of cardiologists with aim to promote the involvement in true interdisciplinary stroke care. Prevention of stroke is a key target in risk factor management, particularly in typical cardiac patients with coronary and peripheral artery disease (see p M26-M34, Storey et al.).2
Atrial fibrillation is widely regarded as a key risk factor for stroke, yet, the complex mechanisms are still a matter of intense research and new conceptual models are developed on mechanisms and treatment regimen of atrial fibrillation (see p M51-M59, Freedman et al.).3 Cardiac interventions for stroke prevention (see p M43-M50, Parrini et al.)4 and even more urgent for acute thrombectomy (see p M13-M18 Lanzer et al.)5 are forward-pressing topics reflecting the high need of improved therapy options. Carotid stenosis is a common problem with heterogeneous individual conditions and adequate clinical and imaging evaluation and treatment decision are continuously evolving (see p M35-M42 Messas et al.).6 Infective endocarditis presents a high-risk situation where fast and decisive action in the indication and the timing of surgical intervention may be needed (see p M19-M25 Bonaros et al.).7 In all these settings cardiologists should be regularly involved in the evaluation and treatment decisions of stroke patients.
The ESC Council on Stroke is dedicated to promote the education and research on the multifaceted interaction between the heart and the brain. Council membership is free and with over 2,000 members the council is reaching out to all colleagues and partners involved in state of the art stroke care. The collaboration with partner societies beyond the ESC family is reflected in the activities of the council as in the faculty of the annual international scientific conference ‘ESC Heart & Stroke’.
For more information on the ESC Council on Stroke, visit: www.escardio.org/stroke
Wolfram Doehner Chair of the Council on Stroke (2018–20)
Jan Kovac Chair of the Council on Stroke (2020–22)
Join the ESC Council on Stroke and attend the International Conference to learn more about the heart - stroke interaction at: www.escardio.org/stroke
References
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