{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:43:30Z","timestamp":1788176610080,"version":"build-2803163510"},"reference-count":331,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>\n                    The heart and brain are anatomically and functionally interconnected through nervous and humoral feedback mechanisms. Under physiological conditions, the heart-brain axis helps maintain cardiovascular and cerebral homeostasis. Pathology affecting one organ can profoundly impact the other, significantly worsening prognosis. The term\n                    <jats:italic>stroke\u2013heart syndrome<\/jats:italic>\n                    refers to cardiovascular complications following acute ischemic stroke, including myocardial injury, infarction, ventricular dysfunction, arrhythmias (e.g., atrial fibrillation), heart failure, takotsubo syndrome, and sudden cardiac death. Brain damage-induced cardiac injury arises from a complex interplay of neuroinflammation, systemic immune activation, sympathetic-immune interactions, catecholamine toxicity, endothelial dysfunction, and gut\u2013brain\u2013heart axis involvement. Conversely, cardiac conditions, including myocardial ischemia, heart failure, and atrial fibrillation, are associated with an increased risk of stroke and cognitive decline. Myocardial ischemia can initiate systemic inflammation and neuroinflammation through sympathetic overdrive and platelet activation. Heart failure causes cerebral hypoperfusion and high thromboembolic risk, and atrial fibrillation promotes thrombus formation due to blood stasis. Atrial dysfunction and prothrombotic states may also occur independently of arrhythmia. This review summarises current evidence on the pathological interactions within the heart\u2013brain axis, in the context of stroke, mental stress, ischemic heart disease, heart failure, and atrial fibrillation.\n                  <\/jats:p>","DOI":"10.3389\/fcvm.2026.1681715","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T04:37:39Z","timestamp":1776832659000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Heart-brain axis pathophysiological understanding and clinical impact"],"prefix":"10.3389","volume":"13","author":[{"given":"Federico","family":"Vancheri","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, S. Elia Hospital","place":["Caltanissetta, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Vancheri","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Department, Besan\u00e7on University Hospital","place":["Besan\u00e7on, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Longo","sequence":"additional","affiliation":[{"name":"Cardiovascular and Interventional Department, S. Elia Hospital","place":["Caltanissetta, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Vancheri","sequence":"additional","affiliation":[{"name":"Department of Neurology, H\u00f4pital Lariboisi\u00e8re","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Y.","family":"Henein","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e425","DOI":"10.1161\/STR.0000000000000476","article-title":"Cardiac contributions to brain health: a scientific statement from the American Heart Association","volume":"55","author":"Testai","year":"2024","journal-title":"Stroke"},{"key":"B2","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1038\/s41569-025-01140-3","article-title":"The brain\u2013heart axis: integrative cooperation of neural, mechanical and biochemical pathways","volume":"22","author":"Valenza","year":"2025","journal-title":"Nat Rev Cardiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1745","DOI":"10.1007\/s11886-023-01990-8","article-title":"The brain\u2013heart axis: neuroinflammatory interactions in cardiovascular disease","volume":"25","author":"Hu","year":"2023","journal-title":"Curr Cardiol Rep"},{"key":"B4","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1097\/CD9.0000000000000156","article-title":"The heart-brain axis: key concepts in neurocardiology","volume":"5","author":"Goh","year":"2025","journal-title":"Cardiology Discovery"},{"key":"B5","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1038\/nrcardio.2012.45","article-title":"Stress and cardiovascular disease","volume":"9","author":"Steptoe","year":"2012","journal-title":"Nat Rev Cardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1097\/01.psy.0000155663.93160.d2","article-title":"Behavioral and emotional triggers of acute coronary syndromes: a systematic review and critique","volume":"67","author":"Strike","year":"2005","journal-title":"Psychosom Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1161\/01.CIR.101.2.158","article-title":"Destabilizing effects of mental stress on ventricular arrhythmias in patients with implantable cardioverter-defibrillators","volume":"101","author":"Lampert","year":"2000","journal-title":"Circulation"},{"key":"B8","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1177\/2047487316686435","article-title":"Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients","volume":"24","author":"Sun","year":"2017","journal-title":"Eur J Prev Cardiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/S1474-4422(11)70291-5","article-title":"Cardiovascular and neurological causes of sudden death after ischaemic stroke","volume":"11","author":"S\u00f6r\u00f6s","year":"2012","journal-title":"Lancet Neurol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1161\/STROKEAHA.119.027732","article-title":"Brain-heart interactions during ischemic processes: clinical and experimental evidences","volume":"51","author":"M\u00e9loux","year":"2020","journal-title":"Stroke"},{"key":"B11","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1007\/s00109-021-02154-3","article-title":"Cerebral derailment after myocardial infarct: mechanisms and effects of the signaling from the ischemic heart to brain","volume":"100","author":"Gelosa","year":"2022","journal-title":"J Mol Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"183","DOI":"10.3233\/JAD-132363","article-title":"Heart diseases and long-term risk of dementia and Alzheimer\u2019s disease: a population-based CAIDE study","volume":"42","author":"Rusanen","year":"2014","journal-title":"J Alzheimer\u2019s Dis"},{"key":"B13","doi-asserted-by":"publisher","first-page":"135","DOI":"10.2147\/CLEP.S30621","article-title":"Heart disease as a risk factor for dementia","volume":"5","author":"Justin","year":"2013","journal-title":"Clin Epidemiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e0184244","DOI":"10.1371\/journal.pone.0184244","article-title":"Coronary heart disease and risk for cognitive impairment or dementia: systematic review and meta-analysis","volume":"12","author":"Deckers","year":"2017","journal-title":"PLoS One"},{"key":"B15","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1002\/ejhf.1100","article-title":"Heart and brain interaction in patients with heart failure: overview and proposal for a taxonomy. 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