HEart and BRain interfaces in Acute ischemic Stroke (HEBRAS)--rationale and design of a prospective oberservational cohort study.
BACKGROUND
An effective diagnostic work-up in hospitalized patients with acute ischemic stroke is vital to optimize secondary stroke prevention. The HEart and BRain interfaces in Acute ischemic Stroke (HEBRAS) study aims to assess whether an enhanced MRI set-up and a prolonged Holter-ECG monitoring yields a higher rate of pathologic findings as compared to diagnostic procedures recommended by guidelines (including stroke unit monitoring for at least 24 h, echocardiography and ultrasound of brain-supplying arteries).


METHODS
Prospective observational single-center study in 475 patients with acute ischemic stroke and without known atrial fibrillation. Patients will receive routine diagnostic care in hospital as wells as brain MRI, cardiac MRI, MR angiography of the brain-supplying arteries and Holter-monitoring for up to 10 days. Study patients will be followed up for cardiovascular outcomes at 3 and 12 months after enrollment.


CONCLUSIONS
By comparing the results of routine diagnostic care to the study-specific MRI/ECG approach, the primary outcome of HEBRAS is the proportion of stroke patients with pathologic diagnostic findings. Predefined secondary outcomes are the association of stroke localization, autonomic dysbalance and cardiac dysfunction as well as the effect of impaired heart-rate-variability on long-term clinical outcome. The investigator-initiated HEBRAS study will assess whether an enhanced MRI approach and a prolonged ECG monitoring yield a higher rate of pathological findings than current standard diagnostic care to determine stroke etiology. These findings might influence current diagnostic recommendations after acute ischemic stroke. Moreover, HEBRAS will determine the extent and clinical impact of stroke-induced cardiac damage.


BACKGROUND
Clinicaltrials.gov NCT02142413.
Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany. georg.haeusler@charite.de.|Department of Neurology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany. georg.haeusler@charite.de.
Karl Georg
KG
Haeusler
Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany. ulrike.grittner@charite.de.|Department for Biostatistics and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany. ulrike.grittner@charite.de.
Ulrike
U
Grittner
Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany. jochen.fiebach@charite.de.
Jochen B
JB
Fiebach
Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany. matthias.endres@charite.de.|Department of Neurology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany. matthias.endres@charite.de.|Excellence Cluster NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany. matthias.endres@charite.de.|German Center for Neurodegenerative Diseases, Berlin, Germany. matthias.endres@charite.de.|German Center for Cardiovascular Diseases, Partner Site Berlin, Berlin, Germany. matthias.endres@charite.de.|Berlin Institute of Health, Berlin, Germany. matthias.endres@charite.de.
Matthias
M
Endres
Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany. thomas.krause@charite.de.|Department of Neurology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany. thomas.krause@charite.de.
Thomas
T
Krause
Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany. christian.nolte@charite.de.|Department of Neurology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany. christian.nolte@charite.de.
Christian H
CH
Nolte
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis*; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000175:diagnosis*; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis*; D002560:Cerebrovascular Circulation; D015331:Cohort Studies; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006760:Hospitalization; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055502:Secondary Prevention; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult