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The cardiac diagnostic work-up in stroke patients-A subanalysis of the Find-AFRANDOMISED trial

Katrin Wasser1, Mark Weber-Krüger2, Falko Jürries2

  • 1Clinic for Neurology, University of Göttingen, Göttingen, Germany.

Plos One
|May 10, 2019
PubMed

Insights

Enhanced Holter-ECG monitoring significantly impacts therapeutic decisions in stroke patients by detecting atrial fibrillation. Echocardiography identifies high-risk patients but rarely changes therapy, suggesting a need for further investigation.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Diagnostics

Background:

  • The optimal cardiac diagnostic workup for stroke patients remains debated, particularly the roles of echocardiography and prolonged Holter-ECG monitoring.
  • Evaluating the impact of detected pathologies on treatment and prognosis is crucial for acute ischemic stroke management.

Purpose of the Study:

  • To analyze the impact of echocardiography and Holter-ECG monitoring findings on therapeutic decisions and patient prognosis in acute ischemic stroke.
  • To compare the effectiveness of enhanced, prolonged Holter-ECG monitoring versus routine care in guiding treatment.

Main Methods:

  • A prospective, multicenter study (Find-AFRANDOMISED) randomized 398 ischemic stroke patients (≥60 years) to enhanced Holter-ECG or usual care.
  • Substudy compared therapeutic changes from echocardiography (TTE, TEE) and Holter-ECG (routine vs. enhanced/prolonged) and assessed patient prognosis.

Main Results:

  • Enhanced Holter-ECG monitoring detected atrial fibrillation (AF) in 27/200 patients, leading to therapy changes (NNCD 8). Routine ECG found AF in 12/198 (NNCD 17).
  • Transesophageal echocardiography (TEE) pathologies changed therapy in 14/89 cases (NNCD 12), while transthoracic echocardiography (TTE) changed therapy in 1/90 cases (NNCD 330).
  • Therapeutic decisions were most frequently altered by enhanced and prolonged Holter-ECG monitoring.

Conclusions:

  • Enhanced and prolonged Holter-ECG monitoring should be prioritized in future stroke guidelines due to its significant impact on therapeutic decisions.
  • Echocardiography identifies high-risk cardiovascular patients but infrequently leads to treatment changes, warranting further investigation by neurocardiologic teams.
Abstract

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