Advances in the Study of Cerebrocardiac Syndrome and Its Forensic Significance

doi:10.12116/j.issn.1004-5619.2024.440303

Abstract

Abstract:

Cerebrocardiac syndrome refers to secondary cardiac damage caused by various craniocerebral injury lesions, which can exacerbate existing heart disease. In the practice of forensic pathology, cerebral-cardiac interaction is often ignored in cases of death with a short time after craniocerebral injury, especially those with underlying heart disease. This article reviews the pathogenesis of cerebrocardiac syndrome by summarizing recent research results of cerebrocardiac syndrome at home and abroad and discusses its significance in the field of forensic medicine. The aim is to provide assistance for forensic medicine practice of cerebrocardiac syndrome.

Key words: forensic pathology, cerebrocardiac syndrome, craniocerebral injury, review

CLC Number:

Jian-feng WANG, Chen-teng YANG, Guo-zhong ZHANG, Bin CONG. Advances in the Study of Cerebrocardiac Syndrome and Its Forensic Significance[J]. Journal of Forensic Medicine, 2024, 40(4): 372-378.

References 60

1	LIN H B， LI F X， ZHANG J Y， et al. Cerebral-cardiac syndrome and diabetes： Cardiac damage after ischemic stroke in diabetic state[J]. Front Immunol，2021，12：737170. doi：10.3389/fimmu.2021.737170 .
2	TAHSILI-FAHADAN P， GEOCADIN R G. Heart-brain axis： Effects of neurologic injury on cardiovascular function[J]. Circ Res，2017，120（3）：559-572. doi：10.1161/CIRCRESAHA.116.308446 .
3	郑钰蓉，殷梅，罗悯. 急性缺血性脑卒中伴发脑心综合征的临床研究[J].医学信息，2022，35（17）：156-160. doi：10.3969/j.issn.1006-1959.2022.17.043 .
	ZHENG Y R， YIN M， LUO M. Clinical study of acute ischemic stroke with cerebrocardiac syndrome[J]. Yixue Xinxi，2022，35（17）：156-160.
4	WANG J， ZHANG J， YE Y， et al. Peripheral organ injury after stroke[J]. Front Immunol，2022，13：901209. doi：10.3389/fimmu.2022.901209 .
5	LI W， LI L， CHOPP M， et al. Intracerebral hemorrhage induces cardiac dysfunction in mice without primary cardiac disease[J]. Front Neurol，2018，9：965. doi：10.3389/fneur.2018.00965 .
6	SPOSATO L A， LAM M， ALLEN B， et al. First-ever ischemic stroke and increased risk of incident heart disease in older adults[J]. Neurology，2020，94（15）：e1559-e1570. doi：10.1212/WNL.0000000000009234 .
7	MORRIS N A， CHATTERJEE A， ADEJUMO O L， et al. The risk of Takotsubo cardiomyopathy in acute neurological disease[J]. Neurocrit Care，2019，30（1）：171-176. doi：10.1007/s12028-018-0591-z .
8	CHEN Z， VENKAT P， SEYFRIED D， et al. Brain-heart interaction： Cardiac complications after stroke[J]. Circ Res，2017，121（4）：451-468. doi：10.1161/CIRCRE SAHA.117.311170 .
9	ZHAO B， LI T， FAN Z， et al. Heart-brain connections： Phenotypic and genetic insights from magnetic resonance images[J]. Science，2023，380（6648）：abn6598. doi：10.1126/science.abn6598 .
10	WANG M， PENG Y. Advances in brain-heart syndrome： Attention to cardiac complications after ische-mic stroke[J]. Front Mol Neurosci，2022，15：1053478. doi：10.3389/fnmol.2022.1053478 .
11	BALINT B， JAREMEK V， THORBURN V， et al. Left atrial microvascular endothelial dysfunction， myocardial inflammation and fibrosis after selective insular cortex ischemic stroke[J]. Int J Cardiol，2019，292：148-155. doi：10.1016/j.ijcard.2019.06.004 .
12	KRAUSE T， WERNER K， FIEBACH J B， et al. Stroke in right dorsal anterior insular cortex is related to myocardial injury[J]. Ann Neurol，2017，81（4）：502-511. doi：10.1002/ana.24906 .
13	BATTAGLINI D， ROBBA C， LOPES DA SILVA A， et al. Brain-heart interaction after acute ischemic stroke[J]. Crit Care，2020，24（1）：163. doi：10.1186/s13054-020-02885-8 .
14	SCHEITZ J F， NOLTE C H， DOEHNER W， et al. Stroke-heart syndrome： Clinical presentation and underlying mechanisms[J]. Lancet Neurol，2018，17（12）：1109-1120. doi：10.1016/S1474-4422（18）30336-3 .
15	WANG Y， HU H， YIN J， et al. TLR4 participates in sympathetic hyperactivity post-MI in the PVN by regulating NF-κB pathway and ROS production[J]. Redox Biol，2019，24：101186. doi：10.1016/j.redox.2019.101186 .
16	INFANGER D W， CAO X， BUTLER S D， et al. Silencing Nox4 in the paraventricular nucleus improves myocardial infarction-induced cardiac dysfunction by attenuating sympathoexcitation and periinfarct apoptosis[J]. Circ Res，2010，106（11）：1763-1774. doi：10.1161/CIRCRESAHA.109.213025 .
17	NISTOR I R， GHERASIM L. From neurocardiology to stroke-heart syndrome[J]. Rom J Intern Med，2023，61（4）：177-185. doi：10.2478/rjim-2023-0020 .
18	DU Y X， DEMILLARD L J， REN J. Catecholamine-induced cardiotoxicity： A critical element in the pathophysiology of stroke-induced heart injury[J]. Life Sci，2021，287：120106. doi：10.1016/j.lfs.2021.120106 .
19	XU H X， CUI S M， ZHANG Y M， et al. Mitochondrial Ca²⁺ regulation in the etiology of heart failure： Physiological and pathophysiological implications[J]. Acta Pharmacol Sin，2020，41（10）：1301-1309. doi：10.1038/s41401-020-0476-5 .
20	ANDREIS D T， SINGER M. Catecholamines for inflammatory shock： A Jekyll-and-Hyde conundrum[J]. Intensive Care Med，2016，42（9）：1387-1397. doi：10.1007/s00134-016-4249-z .
21	郭彩霞，杜凤和，陈瑞芬，等. 大鼠颅脑损伤后心肌损害和血浆及心肌血管紧张素的变化[J].基础医学与临床，2003，23（1）：72-75. doi：10.3969/j.issn.1001-6325.2003.01.016 .
	GUO C X， DU F H， CHEN R F， et al. Myocardial damage， changes of plasma A Ⅱ as well as myocardial A Ⅱ and AT₁ receptor after brain injury in rats[J]. Jichu Yixue Yu Linchuang，2003，23（1）：72-75.
22	LU Y， LI S， WU H， et al. Beneficial effects of astragaloside Ⅳ against angiotensin Ⅱ-induced mitochondrial dysfunction in rat vascular smooth muscle cells[J]. Int J Mol Med，2015，36（5）：1223-1232. doi：10.3892/ijmm.2015.2345 .
23	LIJNEN P J， VAN PELT J F， FAGARD R H. Downregulation of manganese superoxide dismutase by angiotensin Ⅱ in cardiac fibroblasts of rats： Association with oxidative stress in myocardium[J]. Am J Hypertens，2010，23（10）：1128-1135. doi：10.1038/ajh.2010.128 .
24	王东晨，高源勋，孟昭阳. 中西医治疗脑心综合征的研究进展[J].中西医结合心脑血管病杂志，2021，19（4）：611-614. doi：10.12102/j.issn.1672-1349.2021.04.021 .
	WANG D C， GAO Y X， MENG Z Y. Research progress of cerebrocardiac syndrome treated by traditional Chinese and western medicine[J]. Zhongxiyi Jiehe Xinnaoxueguanbing Zazhi，2021，19（4）：611-614.
25	刘文通，赵轩竹，陈宝贵. 脑心综合征的中西医研究进展[J].中医药导报，2020，26（10）：151-153，164. doi：10.13862/j.cnki.cn43-1446/r.2020.10.036 .
	LIU W T， ZHAO X Z， CHEN B G. Research advancements of traditional Chinese and western medicine in cerebral-cardiac syndrome[J]. Zhongyiyao Daobao，2020，26（10）：151-153，164.
26	VAN DER BILT I A C， VENDEVILLE J P， VAN DE HOEF T P， et al. Myocarditis in patients with subarachnoid hemorrhage： A histopathologic study[J]. J Crit Care，2016，32：196-200. doi：10.1016/j.jcrc.2015.12.005 .
27	DENG S W， CHEN X Q， LEI Q， et al. AQP2 promotes astrocyte activation by modulating the TLR4/NFκB-p65 pathway following intracerebral hemorrhage[J]. Front Immunol，2022，13：847360. doi：10 .
	3389/fimmu.2022.847360.
28	ZHAO H， ZHANG K， TANG R， et al. TRPV4 blockade preserves the blood-brain barrier by inhi-biting stress fiber formation in a rat model of intracerebral hemorrhage[J]. Front Mol Neurosci，2018，11：97. doi：10.3389/fnmol.2018.00097 .
29	LI W， LI L， LI W， et al. Spleen associated immune-response mediates brain-heart interaction after intracerebral hemorrhage[J]. Exp Neurol，2020，327：113209. doi：10.1016/j.expneurol.2020.113209 .
30	WANG L F， NEGRO R， WU H. TRPM2， linking oxidative stress and Ca²⁺ permeation to NLRP3 inflammasome activation[J]. Curr Opin Immunol，2020，62：131-135. doi：10.1016/j.coi.2020.01.005 .
31	HE W， CHEN P， CHEN Q， et al. Cytokine storm： Behind the scenes of the collateral circulation after acute myocardial infarction[J]. Inflamm Res，2022，71（10/11）：1143-1158. doi：10.1007/s00011-022-01611-0 .
32	KUMAR S， WANG G， ZHENG N， et al. HIMF （hypoxia-induced mitogenic factor）-IL （interleukin）-6 signaling mediates cardiomyocyte-fibroblast crosstalk to promote cardiac hypertrophy and fibrosis[J]. Hypertension，2019，73（5）：1058-1070. doi：10.1161/hyperten sionaha.118.12267 .
33	ZHENG J， MA Y， GUO X， et al. Immunological characterization of stroke-heart syndrome and identification of inflammatory therapeutic targets[J]. Front Immunol，2023，14：1227104. doi：10.3389/fimmu.2023.1227104 .
34	XU C， ZHENG A， HE T， et al. Brain-heart axis and biomarkers of cardiac damage and dysfunction after stroke： A systematic review and meta-analysis[J]. Int J Mol Sci，2020，21（7）：2347. doi：10.3390/ijms21072347 .
35	CRAPSER J， RITZEL R， VERMA R， et al. Ischemic stroke induces gut permeability and enhances bacterial translocation leading to sepsis in aged mice[J]. Aging，2016，8（5）：1049-1063. doi：10.18632/aging.100952 .
36	LI X J， YOU X Y， WANG C Y， et al. Bidirectional Brain-gut-microbiota Axis in increased intestinal permeability induced by central nervous system injury[J]. CNS Neurosci Ther，2020，26（8）：783-790. doi：10.1111/cns.13401 .
37	PAN P， SONG Y， DU X， et al. Intestinal barrier dysfunction following traumatic brain injury[J]. Neurol Sci，2019，40（6）：1105-1110. doi：10.1007/s10072-019-03739-0 .
38	WEN S W， WONG C H Y. An unexplored brain-gut microbiota axis in stroke[J]. Gut Microbes，2017，8（6）：601-606. doi：10.1080/19490976.2017.1344809 .
39	GAO H， LIU S. Role of uremic toxin indoxyl sulfate in the progression of cardiovascular disease[J]. Life Sci，2017，185：23-29. doi：10.1016/j.lfs.2017.07.027 .
40	LEKAWANVIJIT S， ADRAHTAS A， KELLY D J， et al. Does indoxyl sulfate， a uraemic toxin， have direct effects on cardiac fibroblasts and myocytes?[J]. Eur Heart J，2010，31（14）：1771-1779. doi：10.1093/eurheartj/ehp574 .
41	WITKOWSKI M， WEEKS T L， HAZEN S L. Gut microbiota and cardiovascular disease[J]. Circ Res，2020，127（4）：553-570. doi：10.1161/CIRCRESAHA.120.316242 .
42	NEMET I， SAHA P P， GUPTA N， et al. A cardiovascular disease-linked gut microbial metabolite acts via adrenergic receptors[J]. Cell，2020，180（5）：862-877.e22. doi：10.1016/j.cell.2020.02.016 .
43	ZHOU Y， DENG L， ZHAO D， et al. MicroRNA-503 promotes angiotensin Ⅱ-induced cardiac fibrosis by targeting Apelin-13[J]. J Cell Mol Med，2016，20（3）：495-505. doi：10.1111/jcmm.12754 .
44	CHEN J， CUI C， YANG X， et al. MiR-126 affects brain-heart interaction after cerebral ischemic stroke[J]. Transl Stroke Res，2017，8（4）：374-385. doi：10.1007/s12975-017-0520-z .
45	ZHANG L， LIU T， WANG P， et al. Overexpression of long noncoding RNA H19 inhibits cardiomyocyte apoptosis in neonatal rats with hypoxic-ischemic brain damage through the miR-149-5p/LIF/PI3K/Akt axis[J]. Biopreserv Biobank，2021，19（5）：376-385. doi：10.1089/bio.2020.0088 .
46	CLIMENT M， QUINTAVALLE M， MIRAGOLI M， et al. TGFβ triggers miR-143/145 transfer from smooth muscle cells to endothelial cells， thereby modu-lating vessel stabilization[J]. Circ Res，2015，116（11）：1753-1764. doi：10.1161/CIRCRESAHA.116.305178 .
47	WANG L， YUAN Y， LI J， et al. MicroRNA-1 aggravates cardiac oxidative stress by post-transcriptional modification of the antioxidant network[J]. Cell Stress Chaperones，2015，20（3）：411-420. doi：10.1007/s12192-014-0565-9 .
48	WANG M， YANG Y， XU Y. Brain nuclear receptors and cardiovascular function[J]. Cell Biosci，2023，13（1）：14. doi：10.1186/s13578-023-00962-3 .
49	SHIH C D. Activation of estrogen receptor beta-dependent nitric oxide signaling mediates the hypotensive effects of estrogen in the rostral ventrolateral medulla of anesthetized rats[J]. J Biomed Sci，2009，16（1）：60. doi：10.1186/1423-0127-16-60 .
50	XUE B， ZHANG Z， BELTZ T G， et al. Estrogen receptor-β in the paraventricular nucleus and rostroventrolateral medulla plays an essential protective role in aldosterone/salt-induced hypertension in female rats[J]. Hypertension，2013，61（6）：1255-1262. doi：10 .
	1161/HYPERTENSIONAHA.111.00903.
51	KONERU B， BATHINA C S， CHERRY B H， et al. Mineralocorticoid receptor in the NTS stimulates saline intake during fourth ventricular infusions of aldosterone[J]. Am J Physiol Regul Integr Comp Physiol，2014，306（1）：R61-R66. doi：10.1152/ajpregu.00434.2013 .
52	WALTERS K A， EDWARDS M C， TESIC D， et al. The role of central androgen receptor actions in regulating the hypothalamic-pituitary-ovarian axis[J]. Neuroendocrinology，2018，106（4）：389-400. doi：10.1159/000487762 .
53	GHOSAL S， BUNDZIKOVA-OSACKA J， DOLGAS C M， et al. Glucocorticoid receptors in the nucleus of the solitary tract （NTS） decrease endocrine and behavioral stress responses[J]. Psychoneuroendocrino-logy，2014，45：142-153. doi：10.1016/j.psyneuen.2014.03.018 .
54	LEE P W， SELHORST A， LAMPE S G， et al. Neuron-specific vitamin D signaling attenuates microglia activation and CNS autoimmunity[J]. Front Neurol，2020，11：19. doi：10.3389/fneur.2020.00019 .
55	熊昌艳，王永忠，朱宝利，等. 交通事故后心脏自发性破裂1例[J].法医学杂志，2009，25（5）：398-399. doi：10.3969/j.issn.1004-5619.2009.05.033 .
	XIONG C Y， WANG Y Z， ZHU B L， et al. Spontaneous cardiac rupture after a traffic accident： A case report[J]. Fayixue Zazhi，2009，25（5）：398-399.
56	FAN X， DU F H， TIAN J P. The electrocardiographic changes in acute brain injury patients[J]. Chin Med J （Engl），2012，125（19）：3430-3433. doi：10.3760/ cma.j.issn.0366-6999.2012.19.013 .
57	王蒙蒙. 急性脑梗死并发脑心综合征的临床回顾性分析[D].长春：吉林大学，2018.
	WANG M M. Retrospective analysis of acute cerebral infraction and cerebro-cardiac syndrome[D]. Chang-chun： Jilin University，2018.
58	ORAS J， GRIVANS C， BARTLEY A， et al. Elevated high-sensitive troponin T on admission is an indicator of poor long-term outcome in patients with subarachnoid haemorrhage： A prospective observational study[J]. Crit Care，2016，20：11. doi：10.1186/s13054-015-1181-5 .
59	KIM W， CHOI K S， LIM T， et al. Prognostic value of echocardiography for left ventricular dysfunction after aneurysmal subarachnoid hemorrhage： A syste-matic review and meta-analysis[J]. World Neurosurg，2019，126：e1099-e1111. doi：10.1016/j.wneu.2019.03.054 .
60	柴亮，赵子平，曹亚云，等. 超声心动图评估急性脑损伤患者的左心室功能[J].中华医学超声杂志（电子版），2019，16（4）：301-305. doi：10.3877/cma.j.issn.1672-6448.2019.04.012 .
	CHAI L， ZHAO Z P， CAO Y Y， et al. Comparative assessment of left ventricular function in patients with acute brain injury[J]. Zhonghua Yixue Chaosheng Zazhi （Electronic edition），2019，16（4）：301-305.

[1]	Ji-lun LI, Chao LUO, Ying FAN, Jia-wen WANG, Jian-hua ZHANG. Analysis of the Identification Results of Medical Damage in 20 Urological Death Cases [J]. Journal of Forensic Medicine, 2024, 40(4): 359-364.
[2]	Wen-qing GUO, Min CHEN, Ao MA, Ping HUANG, Ji ZHANG. Application of Protease-Hydrogen Peroxide Digestion Method in Forensic Diatom Examination [J]. Journal of Forensic Medicine, 2024, 40(4): 317-323.
[3]	Jin-ting LIU, Li-ying ZHOU, Jia-hong XIANG, Zi-yi LI, Wan-ting XIE, Ke-ming YUN, Yan SHI. Research Progress on Detection of New Psychoactive Substance Piperazines in vivo [J]. Journal of Forensic Medicine, 2024, 40(3): 276-283.
[4]	Wei FANG, Ji-long ZHENG, Yi-ming FU, Yi LIU. Research Progress of Using Canine Olfactory Search for Human Remains [J]. Journal of Forensic Medicine, 2024, 40(3): 269-275.
[5]	Nian-nian CHEN, Jiao-fang YU, Peng WU, Li LUO, Ya-qin BAI, Li-kai WANG, Xiao-qian LI, Zhan-peng LI, Cai-rong GAO, Xiang-jie GUO. Urine Metabolites Changes in Acute Myocardial Infarction Rats via Metabolomic Analysis [J]. Journal of Forensic Medicine, 2024, 40(3): 227-236.
[6]	Lei SHI, Ye XUE, Li-rong QIU, Ting LU, Fei FAN, Yu-chi ZHOU, Zhen-hua DENG. Research Progress on Dental Age Estimation Based on MRI Technology [J]. Journal of Forensic Medicine, 2024, 40(2): 112-117.
[7]	Shang-heng CHEN, Sheng-zhong DONG, Zhi-min WANG, Guang-hui HONG, Xing YE, Zi-jie LIN, Jun-yi LIN, Jie-qing JIANG, Shou-yu WANG, Han-cheng LIN, Yi-wen SHEN. Biomarkers Screening and Mechanisms Analysis of the Restraint Stress-Induced Myocardial Injury in Hyperlipidemia ApoE^-/- Mice [J]. Journal of Forensic Medicine, 2024, 40(2): 172-178.
[8]	Juan-juan WU, Jun-jie HUANG, Yu ZHANG, Jia-ying ZHUO, Gang CHEN, Shu-han YANG, Yun-qi ZHAO, Yan-yan FAN. Time-Dependent Sequential Changes of IL-10 and TGF-β1 in Mice with Deep Vein Thrombosis [J]. Journal of Forensic Medicine, 2024, 40(2): 179-185.
[9]	Dan-yang LI, Yu PAN, Hui-ming ZHOU, Lei WAN, Cheng-tao LI, Mao-wen WANG, Ya-hui WANG. Application of Medical Statistical and Machine Learning Methods in the Age Estimation of Living Individuals [J]. Journal of Forensic Medicine, 2024, 40(2): 118-127.
[10]	Yan-ru YAO, Jing JIN, Ying-jie WANG, Jin-zhuan ZHANG, Ying-zhe LI, Yong-xin XU. Research Progress on Biological Evidence Identification in Fire Scenes [J]. Journal of Forensic Medicine, 2024, 40(1): 64-69.
[11]	Wen-jing HU, Ting-ting YANG, Ya-ya WANG, Jiang-wei YAN. The Latest Research Progress on Cell-Free DNA and Prospects of Its Forensic Application [J]. Journal of Forensic Medicine, 2024, 40(1): 70-76.
[12]	Yun-hong XING, Yang LI, Wen-zheng WANG, Liang-liang WANG, Le-le SUN, Qiu-xiang DU, Jie CAO, Guang-long HE, Jun-hong SUN. Pathological Characteristics and Classification of Unstable Coronary Atherosclerotic Plaques [J]. Journal of Forensic Medicine, 2024, 40(1): 59-63.
[13]	Tian TIAN, Xin-biao LIAO, Fu ZHANG, Kai-fei DENG, Ji ZHANG, Ping HUANG, Yi-jiu CHEN, Jian-hua ZHANG. Forensic Pathological Diagnosis of Acute and Old Myocardial Infarction Using Fourier Transform Infrared Spectroscopy [J]. Journal of Forensic Medicine, 2023, 39(6): 535-541.
[14]	Bin YANG, Lu-yao XU, Ling-yue LI, Dong-fang QIAO, Si-hao DU, Xia YUE, Hui-jun WANG. Pathological Changes and Cause of Death Associated with the Global Novel Coronavirus Disease （COVID-19） [J]. Journal of Forensic Medicine, 2023, 39(6): 586-595.
[15]	Xin ZHAO, Zhi-ming CHEN, Wen-yun LIU, Bo WANG, Hong-yang LI, Li-yao YANG, Yan TENG, Li-jun WANG, Yan-bin GAO, Wei-long CHEN, Lei ZHANG. Application of Targeted Coronary Angiography in the Diagnosis of Sudden Cardiac Death [J]. Journal of Forensic Medicine, 2023, 39(6): 542-548.