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  - Tütüncü, Serdar
A1  - Olma, Manuel C.
A1  - Kunze, Claudia
A1  - Krämer, Michael
A1  - Dietzel, Joanna
A1  - Schurig, Johannes
A1  - Filser, Paula
A1  - Pfeilschifter, Waltraud
A1  - Hamann, Gerhard F.
A1  - Büttner, Thomas
A1  - Heuschmann, Peter U.
A1  - Kirchhof, Paulus
A1  - Laufs, Ulrich
A1  - Nabavi, Darius G.
A1  - Röther, Joachim
A1  - Thomalla, Götz
A1  - Veltkamp, Roland
A1  - Eckardt, Kai‐Uwe
A1  - Haeusler, Karl Georg
A1  - Endres, Matthias
T1  - Levels and dynamics of estimated glomerular filtration rate and recurrent vascular events and death in patients with minor stroke or transient ischemic attack
JF  - European Journal of Neurology
N2  - Background and purpose
Impaired kidney function is associated with an increased risk of vascular events in acute stroke patients, when assessed by single measurements of estimated glomerular filtration rate (eGFR). It is unknown whether repeated measurements provide additional information for risk prediction.
Methods
The MonDAFIS (Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke) study randomly assigned 3465 acute ischemic stroke patients to either standard procedures or an additive Holter electrocardiogram. Baseline eGFR (CKD‐EPI formula) were dichotomized into values of < versus ≥60 ml/min/1.73 m\(^{2}\). eGFR dynamics were classified based on two in‐hospital values as “stable normal” (≥60 ml/min/1.73 m\(^{2}\)), “increasing” (by at least 15% from baseline, second value ≥ 60 ml/min/1.73 m\(^{2}\)), “decreasing” (by at least 15% from baseline of ≥60 ml/min/1.73 m\(^{2}\)), and “stable decreased” (<60 ml/min/1.73 m\(^{2}\)). The composite endpoint (stroke, major bleeding, myocardial infarction, all‐cause death) was assessed after 24 months. We estimated hazard ratios in confounder‐adjusted models.
Results
Estimated glomerular filtration rate at baseline was available in 2947 and a second value in 1623 patients. After adjusting for age, stroke severity, cardiovascular risk factors, and randomization, eGFR < 60 ml/min/1.73 m\(^{2}\) at baseline (hazard ratio [HR] = 2.2, 95% confidence interval [CI] = 1.40–3.54) as well as decreasing (HR = 1.79, 95% CI = 1.07–2.99) and stable decreased eGFR (HR = 1.64, 95% CI = 1.20–2.24) were independently associated with the composite endpoint. In addition, eGFR < 60 ml/min/1.732 at baseline (HR = 3.02, 95% CI = 1.51–6.10) and decreasing eGFR were associated with all‐cause death (HR = 3.12, 95% CI = 1.63–5.98).
Conclusions
In addition to patients with low eGFR levels at baseline, also those with decreasing eGFR have increased risk for vascular events and death; hence, repeated estimates of eGFR might add relevant information to risk prediction.
KW  - kidney function
KW  - prognosis
KW  - stroke
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-287271
VL  - 29
IS  - 9
SP  - 2716
EP  - 2724
ER  -