Publications by authors named "Jan F Scheitz"
Background And Aims: Previous observational data indicate that young adults treated with intravenous thrombolysis (IVT) for acute ischemic stroke have more favorable outcomes and less complications when compared to older adults. Given the limited data on this topic, we aimed to provide more evidence on clinical outcomes and safety in such patients, using a large international thrombolysis registry.
Methods: In this prospective multicenter study, we used data from the Thrombolysis in Ischemic Stroke Patients (TRISP) registry from 1998 to 2020.
Cardiovascular alterations are common in patients who had ischaemic stroke, haemorrhagic stroke and other acute brain disorders such as seizures. These cardiac complications are important drivers of morbidity and mortality and comprise blood-based detection of cardiomyocyte damage, ECG changes, heart failure and arrhythmia. Recently, the concept of a distinct 'stroke-heart syndrome' has been formulated as a pathophysiological framework for poststroke cardiac complications.
View Article and Find Full Text PDFIntroduction: The risk of dementia in patients with stroke-heart syndrome (SHS) remains unexplored.
Patients And Methods: Retrospective analysis using the TriNetX network, including patients with ischaemic stroke from 2010 to 2020. These patients were categorised into two groups: those with SHS (heart failure, myocardial infarction, ventricular fibrillation, or Takotsubo cardiomyopathy within 30 days post-stroke) and those without SHS.
Article Synopsis
- Over the past 50 years, more invasive cardiovascular procedures have been performed worldwide, increasing risks of acute brain injury during and after these interventions.
- Current international guidelines often overlook the issue of acute brain injury from cardiovascular procedures, which can lead to worse medical outcomes and higher healthcare costs.
- The international Consensus Statement aims to provide recommendations for prevention, diagnosis, and treatment of this acute brain injury while also highlighting areas where more research is needed.
Background: Atrial fibrillation detected after stroke (AFDAS) is considered to be a distinct entity influenced by cardiogenic and neurogenic factors. We hypothesized that patients with AFDAS have larger stroke lesions than patients without atrial fibrillation (AF) and with known AF (KAF).
Methods And Results: Consecutive patients with magnetic resonance imaging-confirmed acute ischemic stroke admitted to a university hospital between October 2020 and January 2023 were prospectively registered.
Article Synopsis
- Acute myocardial injury, indicated by elevated cardiac troponin I (cTnI) levels, is prevalent in patients with spontaneous intracerebral hemorrhage and linked to worse outcomes.
- The study re-analyzed data from the FAST trial and found that those with myocardial injury had significantly higher odds of poor outcomes and mortality compared to those without.
- Rising cTnI levels were particularly associated with the highest risk, suggesting that monitoring these levels could improve risk assessment post-hemorrhage.
Importance: Elevated values of high-sensitivity cardiac troponin (hs-cTn) are common in patients with acute ischemic stroke and are associated with poor prognosis. However, diagnostic and therapeutic implications in patients with ischemic stroke remain unclear.
Objective: To identify factors indicative of myocardial infarction (MI) in patients with acute ischemic stroke and hs-cTn elevation.
Background: Subclinical myocardial injury in form of hs-cTn (high-sensitivity cardiac troponin) levels has been associated with cognitive impairment and imaging markers of cerebral small vessel disease (SVD) in population-based and cardiovascular cohorts. Whether hs-cTn is associated with domain-specific cognitive decline and SVD burden in patients with stroke remains unknown.
Methods And Results: We analyzed patients with acute stroke without premorbid dementia from the prospective multicenter DEMDAS (DZNE [German Center for Neurodegenerative Disease]-Mechanisms of Dementia after Stroke) study.
Background: Sex differences in presentation, treatment, and prognosis of cardiovascular disorders are well recognized. Although an association between acute myocardial injury and mortality after ischemic stroke has been demonstrated, it is unclear whether prevalence and outcome of poststroke acute myocardial injury differ between women and men.
Methods And Results: We prospectively screened consecutive patients with acute ischemic stroke and serial high-sensitivity cardiac troponin T measurements admitted to our center.
Background: Heart rate turbulence (HRT), an ECG-based marker of autonomic cardiac regulation, has shown high prognostic value in patients with established cardiovascular diseases, while data in patients with acute ischemic stroke are scarce.
Patients And Methods: The HRT parameters turbulence onset and turbulence slope were analyzed using Holter-ECG recordings from patients with acute ischemic stroke, consecutively enrolled in the prospective observational HEBRAS study. HRT was categorized as normal (category 0; both parameters normal), abnormal (category 1; one parameter abnormal), or severely abnormal (category 2; both parameters abnormal).
Background: Stroke-associated pneumonia (SAP) is a preventable determinant for poor outcome after stroke. Machine learning (ML) using large-scale clinical data warehouses may be able to predict SAP and identify patients for targeted interventions. The aim of this study was to develop a prediction model for identifying clinically apparent SAP using automated ML.
View Article and Find Full Text PDFArticle Synopsis
- - The study aims to evaluate the effectiveness of a standard operating procedure for atrial fibrillation (AF) alarms in clinical settings and to assess how well automated monitoring detects AF in patients with ischemic strokes at two hospitals in Berlin.
- - Researchers analyzed ECG data from 109 selected stroke patients who had AF alarms, categorizing the data into AF, non-AF, or artifacts to validate the alarms against patient histories and treatment plans.
- - The primary outcome was to measure the rate of unrecognized AF cases that the monitoring system identified but clinical teams missed, while secondary outcomes focused on potential undiagnosed AF leading to anticoagulant treatment.
Percutaneous left atrial appendage closure (LAAC) has emerged as a non-pharmacological alternative for stroke prevention in patients with atrial fibrillation (AF) not suitable for anticoagulation therapy. Real-world data on peri-procedural outcomes are limited. The aim of this study was to analyze outcomes of peri-procedural safety and healthcare resource utilization in 11,240 adult patients undergoing LAAC in the United States between 2016 and 2019.
View Article and Find Full Text PDFBackground: Retinal artery occlusion (RAO) may lead to irreversible blindness. For acute RAO, intravenous thrombolysis (IVT) can be considered as treatment. However, due to the rarity of RAO, data about IVT safety and effectiveness is limited.
View Article and Find Full Text PDFBackground: 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.
Article Synopsis
- - The World Stroke Organization launched the BEAT initiative to enhance collaboration between cardiologists and stroke physicians at major healthcare facilities, focusing on atrial fibrillation (AF) and poststroke cardiovascular complications.
- - The pilot program included 10 sites across 8 countries and aimed to establish clinical pathways, regular meetings, and integrative roles within stroke teams, successfully achieving objectives in 9 out of 10 sites.
- - Challenges included limited access to certain medications and diagnostic tools, but the initiative led to a more consistent approach in diagnosis and treatment, indicating potential for future programs to improve stroke care.
Article Synopsis
- The study aimed to evaluate the safety and effectiveness of administering intravenous thrombolysis (IVT) between 4.5 to 9 hours after a stroke compared to treatment within 4.5 hours, while also examining the role of advanced neuroimaging for patient selection.
- Out of 15,827 patients, only 663 received IVT between 4.5 to 9 hours post-stroke, with no significant differences found in rates of symptomatic intracranial hemorrhage, poor functional outcomes, or mortality when compared to those treated within 4.5 hours.
- Advanced neuroimaging in patients treated between 4.5 to 9 hours was linked to a 50% reduction in mortality, suggesting that it can
Background: Post-stroke heart rate (HR) and heart rate variability (HRV) changes have been proposed as outcome predictors after stroke. We used data lake-enabled continuous electrocardiograms to assess post-stroke HR and HRV, and to determine the utility of HR and HRV to improve machine learning-based predictions of stroke outcome.
Methods: In this observational cohort study, we included stroke patients admitted to two stroke units in Berlin, Germany, between October 2020 and December 2021 with final diagnosis of acute ischemic stroke or acute intracranial hemorrhage and collected continuous ECG data through data warehousing.
Article Synopsis
- International guidelines advise against using intravenous thrombolysis (IVT) in ischemic stroke patients who have recently taken direct oral anticoagulants (DOAC).
- A multicenter study examined the risk of symptomatic intracranial hemorrhage (sICH) in 832 patients who underwent IVT within 48 hours of DOAC use, compared to over 32,000 controls without recent DOAC intake.
- Results highlighted varied outcomes based on prior DOAC therapy, with focus on sICH incidence measured through established stroke scales, and included an analysis of DOAC levels and reversal treatments prior to IVT.
Background Cerebral microbleeds (CMBs) are increasingly recognized as "covert" brain lesions indicating increased risk of future neurological events. However, data on CMBs in patients undergoing catheter-based structural heart interventions are scarce. Therefore, we assessed occurrence and predictors of new CMBs in patients undergoing catheter-based left atrial appendage closure and percutaneous mitral valve repair using the MitraClip System.
View Article and Find Full Text PDFBackground: Myocardial injury as indicated by elevation of cardiac troponin levels is common after acute ischemic stroke (AIS) and linked to poor outcomes. Previous studies rarely reported on serial hs-cTn measurements to distinguish whether myocardial injury is acute or chronic. Thus, little is known about frequency, associated variables, and outcome of acute myocardial injury in AIS.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates the safety and outcomes of intravenous thrombolysis (IVT) in patients aged 90 and older compared to those younger than 90, using data from the TRISP registry.
- It finds that although the risk of symptomatic intracranial hemorrhage is similar between both age groups, patients aged 90 and older face significantly higher odds of death and poor functional outcomes after treatment.
- The conclusions suggest that while IVT may be just as safe in very elderly patients, the increased mortality and poor recovery rates may not be directly linked to the IVT treatment itself.
After ischemic stroke, there is a significant burden of cardiovascular complications, both in the acute and chronic phase. Severe adverse cardiac events occur in 10% to 20% of patients within the first few days after stroke and comprise a continuum of cardiac changes ranging from acute myocardial injury and coronary syndromes to heart failure or arrhythmia. Recently, the term was introduced to provide an integrated conceptual framework that summarizes neurocardiogenic mechanisms that lead to these cardiac events after stroke.
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