TY  - JOUR
A1  - Schnabel, Renate B.
A1  - Camen, Stephan
A1  - Knebel, Fabian
A1  - Hagendorff, Andreas
A1  - Bavendiek, Udo
A1  - Böhm, Michael
A1  - Doehner, Wolfram
A1  - Endres, Matthias
A1  - Gröschel, Klaus
A1  - Goette, Andreas
A1  - Huttner, Hagen B.
A1  - Jensen, Christoph
A1  - Kirchhof, Paulus
A1  - Korosoglou, Grigorius
A1  - Laufs, Ulrich
A1  - Liman, Jan
A1  - Morbach, Caroline
A1  - Navabi, Darius Günther
A1  - Neumann-Haefelin, Tobias
A1  - Pfeilschifter, Waltraut
A1  - Poli, Sven
A1  - Rizos, Timolaos
A1  - Rolf, Andreas
A1  - Röther, Joachim
A1  - Schäbitz, Wolf Rüdiger
A1  - Steiner, Thorsten
A1  - Thomalla, Götz
A1  - Wachter, Rolf
A1  - Haeusler, Karl Georg
T1  - Expert opinion paper on cardiac imaging after ischemic stroke
JF  - Clinical Research in Cardiology
N2  - This expert opinion paper on cardiac imaging after acute ischemic stroke or transient ischemic attack (TIA) includes a statement of the "Heart and Brain" consortium of the German Cardiac Society and the German Stroke Society. The Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork (AFNET) endorsed this paper. Cardiac imaging is a key component of etiological work-up after stroke. Enhanced echocardiographic tools, constantly improving cardiac computer tomography (CT) as well as cardiac magnetic resonance imaging (MRI) offer comprehensive non- or less-invasive cardiac evaluation at the expense of increased costs and/or radiation exposure. Certain imaging findings usually lead to a change in medical secondary stroke prevention or may influence medical treatment. However, there is no proof from a randomized controlled trial (RCT) that the choice of the imaging method influences the prognosis of stroke patients. Summarizing present knowledge, the German Heart and Brain consortium proposes an interdisciplinary, staged standard diagnostic scheme for the detection of risk factors of cardio-embolic stroke. This expert opinion paper aims to give practical advice to physicians who are involved in stroke care. In line with the nature of an expert opinion paper, labeling of classes of recommendations is not provided, since many statements are based on expert opinion, reported case series, and clinical experience.
KW  - cardiac imaging
KW  - echocardiography
KW  - ischemic stroke
KW  - transient ischemic attack
KW  - expert opinion
KW  - magnetic resonance imaging
KW  - computed tomography
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-266662
SN  - 1861-0692
VL  - 110
IS  - 7
ER  - 
TY  - JOUR
A1  - Herm, Juliane
A1  - Schurig, Johannes
A1  - Martinek, Martin R.
A1  - Höltgen, Reinhard
A1  - Schirdewan, Alexander
A1  - Kirchhof, Paulus
A1  - Wieczorek, Marcus
A1  - Pürerfellner, Helmut
A1  - Heuschmann, Peter U.
A1  - Fiebach, Jochen B.
A1  - Haeusler, Karl Georg
T1  - MRI-detected brain lesions in AF patients without further stroke risk factors undergoing ablation - a retrospective analysis of prospective studies
JF  - BMC Cardiovascular Disorders
N2  - Background
Atrial fibrillation (AF) without other stroke risk factors is assumed to have a low annual stroke risk comparable to patients without AF. Therefore, current clinical guidelines do not recommend oral anticoagulation for stroke prevention of AF in patients without stroke risk factors. We analyzed brain magnetic resonance imaging (MRI) imaging to estimate the rate of clinically inapparent (“silent”) ischemic brain lesions in these patients.

Methods
We pooled individual patient-level data from three prospective studies comprising stroke-free patients with symptomatic AF. All study patients underwent brain MRI within 24–48 h before planned left atrial catheter ablation. MRIs were analyzed by a neuroradiologist blinded to clinical data.

Results
In total, 175 patients (median age 60 (IQR 54–67) years, 32% female, median CHA\(_2\)DS\(_2\)-VASc = 1 (IQR 0–2), 33% persistent AF) were included. In AF patients without or with at least one stroke risk factor, at least one silent ischemic brain lesion was observed in 4 (8%) out of 48 and 10 (8%) out of 127 patients, respectively (p > 0.99). Presence of silent ischemic brain lesions was related to age (p = 0.03) but not to AF pattern (p = 0.77). At least one cerebral microbleed was detected in 5 (13%) out of 30 AF patients without stroke risk factors and 25 (25%) out of 108 AF patients with stroke risk factors (p = 0.2). Presence of cerebral microbleeds was related to male sex (p = 0.04) or peripheral artery occlusive disease (p = 0.03).

Conclusion
In patients with symptomatic AF scheduled for ablation, brain MRI detected silent ischemic brain lesions in approximately one in 12 patients, and microbleeds in one in 5 patients. The prevalence of silent ischemic brain lesions did not differ in AF patients with or without further stroke risk factors.
KW  - Clinically silent stroke
KW  - atrial fibrillation
KW  - magnetic resonance imaging
KW  - cerebral microbleeds
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201226
VL  - 19
ER  -