RT Journal Article
SR Electronic
T1 Enhanced diagnostic workup increases pathological findings in patients with acute ischaemic stroke: results of the prospective HEBRAS study
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 145
OP 152
DO 10.1136/svn-2022-002179
VO 9
IS 2
A1 Hellwig, Simon
A1 Krause, Thomas
A1 Scheitz, Jan F
A1 Herm, Juliane
A1 Grittner, Ulrike
A1 Jauert, Nadja
A1 Fiebach, Jochen B
A1 Kasner, Mario
A1 Doehner, Wolfram
A1 Endres, Matthias
A1 Wachter, Rolf
A1 Elgeti, Thomas
A1 Nolte, Christian H
A1 Haeusler, Karl Georg
YR 2024
UL http://svn.bmj.com/content/9/2/145.abstract
AB Background Stroke aetiology remains cryptogenic in a relevant proportion of patients with acute ischaemic stroke (AIS). We assessed whether enhanced diagnostic workup after AIS yields a higher rate of prespecified pathological findings compared with routine diagnostic care in-hospital.Methods Hospitalised patients with AIS were prospectively enrolled in the investigator-initiated observational HEart and BRain Interfaces in Acute Ischaemic Stroke (HEBRAS) study at the Charité, Berlin, Germany. Patients with AIS without known atrial fibrillation (AF) underwent cardiovascular MR imaging (CMR), MR-angiography of the aortic arch and prolonged Holter-ECG monitoring on top of routine diagnostic care.Results Among 356 patients with AIS (mean age 66 years, 37.6% female), enhanced workup yielded a higher rate of prespecified pathological findings compared with routine care (17.7% vs 5.3%; p<0.001). Consequently, fewer patients were classified as cryptogenic after enhanced diagnostic workup (38.5% vs 45.5%, p<0.001). Routine care included echocardiography in 228 (64.0%) patients. CMR was successfully performed in 292 (82.0%) patients and revealed more often a prespecified pathological finding compared with routine echocardiography (16.1% vs 5.3%). Furthermore, study-related ECG monitoring (median duration 162 hours (IQR 98–210)) detected AF in 16 (4.5%) patients, while routine monitoring (median duration 51 hours (IQR 34–74)) detected AF in seven (2.0%) patients.Conclusions Enhanced diagnostic workup revealed a higher rate of prespecified pathological findings in patients with AIS compared with routine diagnostic care and significantly reduced the proportion of patients with cryptogenic stroke.Trial registration number NCT02142413.Data are available on reasonable request. Individual participant data that underlie the results reported in this article will be available to researchers who provide a methodologically sound proposal beginning at 12 months and ending 5 years after publication. Proposals should be directed to the corresponding author.