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Enhanced diagnostic workup increases pathological findings in patients with acute ischaemic stroke:results of the prospective HEBRAS study

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Stroke & Vascular Neurology 2024年第2期9卷 145-152,I0414-I0425页

作者： Simon Hellwig Thomas Krause Jan F Scheitz Juliane Herm Ulrike Grittner Nadja Jauert Jochen B Fiebach Mario Kasner Wolfram Doehner Matthias Endres Rolf Wachter Thomas Elgeti Christian H Nolte karl georg haeusler Department of Neurology with Experimental Neurology Charité-Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt-Universität zu BerlinBerlinGermany Center for Stroke Research Berlin BerlinGermany Berlin Institute of Health at Charité–Universitätsmedizin Berlin BIH Biomedical Innovation AcademyBerlinGermany Department of Neurology Jüdisches Krankenhaus BerlinBerlinGermany German Center for Cardiovascular Diseases(DZHK) Partner Site BerlinBerlinGermany Institute of Biometry and Clinical Epidemiology Charité-Universitätsmedizin BerlinBerlinGermany BIH Center for Regenerative Therapies(BCRT) Berlin Institute of Health at Charité–Universitätsmedizin BerlinBerlinGermany Department of Cardiology Charité-Universitätsmedizin BerlinBerlinGermany Department of Cardiology Campus Benjamin FranklinCharité-Universitätsmedizin BerlinBerlinGermany German Center for Neurodegenerative Diseases(DZNE) Partner Site BerlinBerlinGermany Department of Cardiology University Hospital LeipzigLeipzigGermany Department of Radiology Charité-Universitätsmedizin BerlinBerlinGermany Department of Neurology University Hospital WürzburgWürzburgGermany

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 *** 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,*** 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 *** 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%)*** 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%)*** 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 *** registration number NCT02142413.

关键词： routine patients prospective

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