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  - 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  - 
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  -