TY - JOUR A1 - Haeusler, Karl Georg A1 - Herm, Juliane A1 - Kunze, Claudia A1 - Krüll, Matthias A1 - Brechtel, Lars A1 - Lock, Jürgen A1 - Hohenhaus, Marc A1 - Heuschmann, Peter U. A1 - Fiebach, Jochen B. A1 - Haverkamp, Wilhelm A1 - Endres, Matthias A1 - Jungehulsing, Gerhard Jan T1 - Rate of cardiac arrhythmias and silent brain lesions in experienced marathon runners: rationale, design and baseline data of the Berlin Beat of Running study JF - BMC Cardiovascular Disorders N2 - Background: Regular exercise is beneficial for cardiovascular health but a recent meta-analysis indicated a relationship between extensive endurance sport and a higher risk of atrial fibrillation, an independent risk factor for stroke. However, data on the frequency of cardiac arrhythmias or (clinically silent) brain lesions during and after marathon running are missing. Methods/Design: In the prospective observational "Berlin Beat of Running" study experienced endurance athletes underwent clinical examination (CE), 3 Tesla brain magnetic resonance imaging (MRI), carotid ultrasound imaging (CUI) and serial blood sampling (BS) within 2-3 days prior (CE, MRI, CUI, BS), directly after (CE, BS) and within 2 days after (CE, MRI, BS) the 38\(^{th}\) BMW BERLIN-MARATHON 2011. All participants wore a portable electrocardiogram (ECG)-recorder throughout the 4 to 5 days baseline study period. Participants with pathological MRI findings after the marathon, troponin elevations or detected cardiac arrhythmias will be asked to undergo cardiac MRI to rule out structural abnormalities. A follow-up is scheduled after one year. Results: Here we report the baseline data of the enrolled 110 athletes aged 36-61 years. Their mean age was 48.8 \(\pm\) 6.0 years, 24.5% were female, 8.2% had hypertension and 2.7% had hyperlipidaemia. Participants have attended a mean of 7.5 \(\pm\) 6.6 marathon races within the last 5 years and a mean of 16 \(\pm\) 36 marathon races in total. Their weekly running distance prior to the 38\(^{th}\) BMW BERLIN-MARATHON was 65 \(\pm\) 17 km. Finally, 108 (98.2%) Berlin Beat-Study participants successfully completed the 38\(^{th}\) BMW BERLIN-MARATHON 2011. Discussion: Findings from the "Berlin Beats of Running" study will help to balance the benefits and risks of extensive endurance sport. ECG-recording during the marathon might contribute to identify athletes at risk for cardiovascular events. MRI results will give new insights into the link between physical stress and brain damage. KW - marathon running KW - cardiac arrhythmia KW - atrial fibrillation KW - physical activity KW - cardiovascular events KW - carotid artery KW - risk factor KW - stroke KW - exercise KW - death KW - metaanalysis KW - mechanisms KW - ECG-recording KW - magnetic resonance imaging KW - blood sampling Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-133677 VL - 12 IS - 69 ER - TY - JOUR A1 - Luger, Sebastian A1 - Hohmann, Carina A1 - Niemann, Daniela A1 - Kraft, Peter A1 - Gunreben, Ignaz A1 - Neumann-Haefelin, Tobias A1 - Kleinschnitz, Christoph A1 - Steinmetz, Helmuth A1 - Foerch, Christian A1 - Pfeilschifter, Waltraud T1 - Adherence to oral anticoagulant therapy in secondary stroke prevention - impact of the novel oral anticoagulants JF - Patient Preference and Adherence N2 - Background: Oral anticoagulant therapy (OAT) potently prevents strokes in patients with atrial fibrillation. Vitamin K antagonists (VKA) have been the standard of care for long-term OAT for decades, but non-VKA oral anticoagulants (NOAC) have recently been approved for this indication, and raised many questions, among them their influence on medication adherence. We assessed adherence to VKA and NOAC in secondary stroke prevention. Methods: All patients treated from October 2011 to September 2012 for ischemic stroke or transient ischemic attack with a subsequent indication for OAT, at three academic hospitals were entered into a prospective registry, and baseline data and antithrombotic treatment at discharge were recorded. At the 1-year follow-up, we assessed the adherence to different OAT strategies and patients' adherence to their respective OAT. We noted OAT changes, reasons to change treatment, and factors that influence persistence to the prescribed OAT. Results: In patients discharged on OAT, we achieved a fatality corrected response rate of 73.3% (n=209). A total of 92% of these patients received OAT at the 1-year follow-up. We observed good adherence to both VKA and NOAC (VKA, 80.9%; NOAC, 74.8%; P=0.243) with a statistically nonsignificant tendency toward a weaker adherence to dabigatran. Disability at 1-year follow-up was an independent predictor of lower adherence to any OAT after multivariate analysis, whereas the choice of OAT did not have a relevant influence. Conclusion: One-year adherence to OAT after stroke is strong (>90%) and patients who switch therapy most commonly switch toward another OAT. The 1-year adherence rates to VKA and NOAC in secondary stroke prevention do not differ significantly between both therapeutic strategies. KW - transient ischemic attack KW - adherence KW - non-VKA oral anticoagulants KW - vitamin K antagonists KW - prevention KW - stroke KW - atrial fibrillation KW - warfarin KW - guidelines KW - scale Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-144477 VL - 9 ER - TY - JOUR A1 - Albers, Gregory W. A1 - Bernstein, Richard A. A1 - Brachmann, Johannes A1 - Camm, John A1 - Easton, J. Donald A1 - Fromm, Peter A1 - Goto, Shinya A1 - Granger, Christopher B. A1 - Hohnloser, Stefan H. A1 - Hylek, Elaine A1 - Jaffer, Amir K. A1 - Krieger, Derk W. A1 - Passman, Rod A1 - Pines, Jesse M. A1 - Reed, Shelby D. A1 - Rothwell, Peter M. A1 - Kowey, Peter R. T1 - Heart Rhythm Monitoring Strategies for Cryptogenic Stroke: 2015 Diagnostics and Monitoring Stroke Focus Group Report JF - Journal of the American Heart Association N2 - No abstract available. KW - anticoagulants KW - atrial fibrillation KW - diagnosis KW - electrocardiography KW - insertable cardiac monitor KW - stroke prevention Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-165709 VL - 5 IS - e00294 ER - TY - JOUR A1 - Malsch, Carolin A1 - Liman, Thomas A1 - Wiedmann, Silke A1 - Siegerink, Bob A1 - Georgakis, Marios K. A1 - Tiedt, Steffen A1 - Endres, Matthias A1 - Heuschmann, Peter U. T1 - Outcome after stroke attributable to baseline factors—the PROSpective Cohort with Incident Stroke (PROSCIS) JF - PLoS ONE N2 - Background The impact of risk factors on poor outcome after ischemic stroke is well known, but estimating the amount of poor outcome attributable to single factors is challenging in presence of multimorbidity. We aim to compare population attributable risk estimates obtained from different statistical approaches regarding their consistency. We use a real-life data set from the PROSCIS study to identify predictors for mortality and functional impairment one year after first-ever ischemic stroke and quantify their contribution to poor outcome using population attributable risks. Methods The PROSpective Cohort with Incident Stroke (PROSCIS) is a prospective observational hospital-based cohort study of patients after first-ever stroke conducted independently in Berlin (PROSCIS-B) and Munich (PROSCIS-M). The association of baseline factors with poor outcome one year after stroke in PROSCIS-B was analysed using multiple logistic regression analysis and population attributable risks were calculated, which were estimated using sequential population attributable risk based on a multiple generalized additive regression model, doubly robust estimation, as well as using average sequential population attributable risk. Findings were reproduced in an independent validation sample from PROSCIS-M. Results Out of 507 patients with available outcome information after 12 months in PROSCIS-B, 20.5% suffered from poor outcome. Factors associated with poor outcome were age, pre-stroke physical disability, stroke severity (NIHSS), education, and diabetes mellitus. The order of risk factors ranked by magnitudes of population attributable risk was almost similar for all methods, but population attributable risk estimates varied markedly between the methods. In PROSCIS-M, incidence of poor outcome and distribution of baseline parameters were comparable. The multiple logistic regression model could be reproduced for all predictors, except pre-stroke physical disability. Similar to PROSCIS-B, the order of risk factors ranked by magnitudes of population attributable risk was almost similar for all methods, but magnitudes of population attributable risk differed markedly between the methods. Conclusions Ranking of risk factors by population impact is not affected by the different statistical approaches. Thus, for a rational decision on which risk factor to target in disease interventions, population attributable risk is a supportive tool. However, population attributable risk estimates are difficult to interpret and are not comparable when they origin from studies applying different methodology. The predictors for poor outcome identified in PROSCIS-B have a relevant impact on mortality and functional impairment one year after first-ever ischemic stroke. KW - ischemic stroke KW - stroke KW - physical activity KW - diabetes mellitus KW - regression analysis KW - hemorrhagic stroke KW - atrial fibrillation KW - hypertension Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-177342 VL - 13 IS - 9 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 - TY - JOUR A1 - Lock, J. F. A1 - Ungeheuer, L. A1 - Borst, P. A1 - Swol, J. A1 - Löb, S. A1 - Brede, E. M. A1 - Röder, D. A1 - Lengenfelder, B. A1 - Sauer, K. A1 - Gremer, C. - T. T1 - Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery JF - Perioperative Medicine N2 - Background Increasing numbers of patients receiving oral anticoagulants are undergoing elective surgery. Low molecular weight heparin (LMWH) is frequently applied as bridging therapy during perioperative interruption of anticoagulation. The aim of this study was to explore the postoperative bleeding risk of patients receiving surgery under bridging anticoagulation. Methods We performed a monocentric retrospective two-arm matched cohort study. Patients that received perioperative bridging anticoagulation were compared to a matched control group with identical surgical procedure, age, and sex. Emergency and vascular operations were excluded. The primary endpoint was the incidence of major postoperative bleeding. Secondary endpoints were minor postoperative bleeding, thromboembolic events, length of stay, and in-hospital mortality. Multivariate analysis explored risk factors of major postoperative bleeding. Results A total of 263 patients in each study arm were analyzed. The patient cohort included the entire field of general and visceral surgery including a large proportion of major oncological resections. Bridging anticoagulation increased the postoperative incidence of major bleeding events (8% vs. 1%; p < 0.001) as well as minor bleeding events (14% vs. 5%; p < 0.001). Thromboembolic events were equally rare in both groups (1% vs. 2%; p = 0.45). No effect on mortality was observed (1.5% vs. 1.9%). Independent risk factors of major postoperative bleeding were full-therapeutic dose of LMWH, renal insufficiency, and the procedure-specific bleeding risk. Conclusion Perioperative bridging anticoagulation, especially full-therapeutic dose LMWH, markedly increases the risk of postoperative bleeding complications in general and visceral surgery. Surgeons should carefully consider the practice of routine bridging. KW - low molecular heparin KW - atrial fibrillation KW - postoperative bleeding KW - thromboembolism KW - anticoagulation KW - bridging KW - antithrombotic therapy KW - warfarin interruption KW - oral anticoagulants KW - management Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-230690 VL - 9 ER - TY - THES A1 - Mederer, Jonathan T1 - Langzeiteffekte der Vorhofohramputation im Rahmen einer kardiochirurgischen Operation bezogen auf Unterschiede bei Patienten und Patientinnen mit Vorhofflimmern und Sinusrhythmus T1 - The long-term effects of left atrial appendage amputation during cardiac surgery related to differences in patients with atrial fibrillation and sinus rhythm N2 - Ziel dieser Längsschnittstudie war die vergleichende Analyse der Effekte einer Amputation des linken Vorhofohres (LAA) im Rahmen einer kardiochirurgischen Operation (OP) bei Patienten und Patientinnen mit präoperativ diagnostiziertem Sinusrhythmus (SR-Gruppe) und Vorhofflimmern (VHF-Gruppe). Eingeschlossen wurden 262 Patienten und Patientinnen (SR-Gruppe n= 167, VHF-Gruppe n=95), die sich von Januar 2010 bis Mai 2013 einer offenen Herz-OP mit begleitender LAA-Amputation an der Klinik und Poliklinik für Herz- Thorax- und thorakale Gefäßchirurgie des Universitätsklinikums Würzburg unterzogen hatten. Erfasst wurden prä-, intra- und postoperative Daten bis zur Entlassung sowie Langzeitdaten nach durchschnittlich 56 Monaten. Die Rate zerebrovaskulärer Ereignisse war im Langzeit-Follow-up in der SR- und VHF-Gruppe nach dem Eingriff nicht signifikant verschieden (>30 d post-OP: 5,1 % vs. 6,1 %, p=0,875). Trotz der LAA-Amputation lag die Gesamtmortalität (>30 d post-OP, alle Todesursachen) in der VHF-Gruppe im Vergleich zur SR-Gruppe risikostratifiziert signifikant höher (26,3 % vs. 7,2 %, HR 2,872, p=0,010). Weiterhin zeigte sich ein Unterschied beim Vergleich von Patienten und Patientinnen mit intermittierendem/chronischem VHF bzw. SR. Hierbei ging ein chronisches VHF (HR=3,614, p=0,006) anders als ein intermittierendes VHF (HR=2,270, p=0,090) mit einem signifikant schlechteren Langzeitüberleben einher. Die aktuelle Datenlage inklusive der vorliegenden Befunde spricht dafür, dass der negative Effekt eines präoperativen VHF auf zerebrovaskuläre Ereignisse bei Patienten und Patientinnen, die sich einer kardiochirurgischen OP unterziehen, durch eine begleitende LAA-Amputation verringert werden kann. Dennoch weist diese Gruppe im Vergleich zu Patienten und Patientinnen mit SR immer noch ein schlechteres Langzeitüberleben auf. Prospektive randomisierte Studien sind notwendig, um allen Betroffenen eine optimale Therapie anbieten zu können. N2 - This longitudinal study aimed to perform a comparative analysis of the effects of an amputation of the left atrial appendage (LAA) in the context of cardiac surgery (kardiochirurgische Operation (OP)) on patients with preoperatively diagnosed sinus rhythm (SR group) and atrial fibrillation (AF group). A total of 262 patients (SR group n=167, AF group n=95) who underwent open-heart surgery with accompanying LAA amputation in the period from January 2010 to May 2013 at the University Medical Centre of Wuerzburg, Germany were included in the study. Pre-, intra- and postoperative data, as well as long-term data after an average of 56 months, were recorded. The rate of cerebrovascular events was not significantly different in the long-term follow-up in the SR and AF groups after the procedure (>30 days post-op: 5.1% vs. 6.1%, p=0.875). Despite the LAA amputation, the overall mortality (>30 d post-OP, all causes of death) was significantly higher in the AF group than in the SR group, risk-stratified (26.3% vs. 7.2%, HR 2.872, p= 0.010). Furthermore, a difference was observed when comparing patients with intermittent/chronic AF respectively SR. In contrast to intermittent AF (HR=2.270, p=0.090), chronic AF (HR=3.614, p=0.006) was associated with a significantly poorer long-term survival rate. The current data situation, including the findings at hand, suggests that the negative effect of preoperative AF on cerebrovascular events in patients undergoing cardiac surgery can be reduced by concomitant LAA amputation. However, this group still has poorer chances of long-term survival compared to patients with SR and prospective randomized studies are thus necessary to be able to offer an optimal therapy to all affected patients. KW - Offene Herzoperation KW - Herzchirurgie KW - Vorhof KW - Vorhofflimmern KW - Linkes Vorhofohr KW - left atrial appendage KW - Vorhofohramputation KW - left atrial appendage closure KW - Sinusrhythmus KW - sinus rhythm KW - atrial fibrillation KW - Schlaganfall Prävention KW - stroke prevention Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-278030 ER - TY - JOUR A1 - Tütüncü, Serdar A1 - Olma, Manuel A1 - Kunze, Claudia A1 - Dietzel, Joanna A1 - Schurig, Johannes A1 - Fiessler, Cornelia A1 - Malsch, Carolin A1 - Haas, Tobias Eberhard A1 - Dimitrijeski, Boris A1 - Doehner, Wolfram A1 - Hagemann, Georg A1 - Hamilton, Frank A1 - Honermann, Martin A1 - Jungehulsing, Gerhard Jan A1 - Kauert, Andreas A1 - Koennecke, Hans-Christian A1 - Mackert, Bruno-Marcel A1 - Nabavi, Darius A1 - Nolte, Christian H. A1 - Reis, Joschua Mirko A1 - Schmehl, Ingo A1 - Sparenberg, Paul A1 - Stingele, Robert A1 - Völzke, Enrico A1 - Waldschmidt, Carolin A1 - Zeise-Wehry, Daniel A1 - Heuschmann, Peter U. A1 - Endress, Matthias A1 - Haeusler, Karl Georg T1 - Off-label-dosing of non-vitamin K-dependent oral antagonists in AF patients before and after stroke: results of the prospective multicenter Berlin Atrial Fibrillation Registry JF - Journal of Neurology N2 - Aims We aimed to analyze prevalence and predictors of NOAC off-label under-dosing in AF patients before and after the index stroke. Methods The post hoc analysis included 1080 patients of the investigator-initiated, multicenter prospective Berlin Atrial Fibrillation Registry, designed to analyze medical stroke prevention in AF patients after acute ischemic stroke. Results At stroke onset, an off-label daily dose was prescribed in 61 (25.5%) of 239 NOAC patients with known AF and CHA2DS2-VASc score ≥ 1, of which 52 (21.8%) patients were under-dosed. Under-dosing was associated with age ≥ 80 years in patients on rivaroxaban [OR 2.90, 95% CI 1.05-7.9, P = 0.04; n = 29] or apixaban [OR 3.24, 95% CI 1.04-10.1, P = 0.04; n = 22]. At hospital discharge after the index stroke, NOAC off-label dose on admission was continued in 30 (49.2%) of 61 patients. Overall, 79 (13.7%) of 708 patients prescribed a NOAC at hospital discharge received an off-label dose, of whom 75 (10.6%) patients were under-dosed. Rivaroxaban under-dosing at discharge was associated with age ≥ 80 years [OR 3.49, 95% CI 1.24-9.84, P = 0.02; n = 19]; apixaban under-dosing with body weight ≤ 60 kg [OR 0.06, 95% CI 0.01-0.47, P < 0.01; n = 56], CHA2DS2-VASc score [OR per point 1.47, 95% CI 1.08-2.00, P = 0.01], and HAS-BLED score [OR per point 1.91, 95% CI 1.28-2.84, P < 0.01]. Conclusion At stroke onset, off-label dosing was present in one out of four, and under-dosing in one out of five NOAC patients. Under-dosing of rivaroxaban or apixaban was related to old age. In-hospital treatment after stroke reduced off-label NOAC dosing, but one out of ten NOAC patients was under-dosed at discharge. KW - NOAC KW - ischemic stroke KW - atrial fibrillation KW - under-dosing Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-266969 SN - 1432-1459 VL - 269 IS - 1 ER - TY - JOUR A1 - Traub, Jan A1 - Frey, Anna A1 - Störk, Stefan T1 - Chronic neuroinflammation and cognitive decline in patients with cardiac disease: evidence, relevance, and therapeutic implications JF - Life N2 - Acute and chronic cardiac disorders predispose to alterations in cognitive performance, ranging from mild cognitive impairment to overt dementia. Although this association is well-established, the factors inducing and accelerating cognitive decline beyond ageing and the intricate causal pathways and multilateral interdependencies involved remain poorly understood. Dysregulated and persistent inflammatory processes have been implicated as potentially causal mediators of the adverse consequences on brain function in patients with cardiac disease. Recent advances in positron emission tomography disclosed an enhanced level of neuroinflammation of cortical and subcortical brain regions as an important correlate of altered cognition in these patients. In preclinical and clinical investigations, the thereby involved domains and cell types of the brain are gradually better characterized. Microglia, resident myeloid cells of the central nervous system, appear to be of particular importance, as they are extremely sensitive to even subtle pathological alterations affecting their complex interplay with neighboring astrocytes, oligodendrocytes, infiltrating myeloid cells, and lymphocytes. Here, we review the current evidence linking cognitive impairment and chronic neuroinflammation in patients with various selected cardiac disorders including the aspect of chronic neuroinflammation as a potentially druggable target. KW - neuroinflammation KW - cognitive impairment KW - dementia KW - myocardial infarction KW - heart failure KW - hypertension KW - coronary artery disease KW - atrial fibrillation KW - cardiac arrest KW - aortic valve stenosis Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304869 SN - 2075-1729 VL - 13 IS - 2 ER -