Clinical trial NCT01541163: Heart and Ischemic STrOke Relationship studY
Official title: Assessment of Relationship Between Acute Ischemic Stroke and Heart Disease
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Brain Ischemia
Acute Stroke
Heart Diseases
Keywords: Ischemia
Brain Infarction
Acute Stroke
Heart Diseases
Myocardial Infarction
Lead sponsor: University Hospital Olomouc
Sponsor class: OTHER
Collaborators: name: Ministry of Health, Czech Republic
name: Palacky University
First posted: 2012-02-29
Enrollment: 500
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Consecutive ischemic stroke patients within 12 hours from stroke onset, who will be admitted at Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc from the October 2010 until December 2015.

Brief summary: Although cardio-embolic etiology of ischemic stroke (IS) is largely respected, there is still no clear recommendation for routine complex cardiological examination in all IS patients. Using complex cardiological examination the investigators expect:

1. more accurate detection of patients with concomitant heart disease (cardiac rhythm disorder, valve disorders, acute coronary syndrome, cardiac thrombus and myxoma, atrial and ventricle septum defects)
2. higher number of etiologically determinated IS, which is crucial for accurate secondary prevention.

Detailed description: The investigators expect significant changes of biochemical parameters (NT pro B-type of natriuretic peptide, pro-atrial natriuretic peptide, creatinkinase MB, troponin T), inflammatory markers (interleukine 6, procalcitonin, high sensitive C-reactive protein), and coagulation parameters in patients with CE IS compared to other causes of IS.

Assessing the glomerular filtration of cystatin C, glycated haemoglobin and serum lipids and its correlation with prior medicament use will allow to evaluate the long-term compensation of arterial hypertension, diabetes mellitus and dyslipidemia in IS patients.

In addition to the above mentioned comprehensive cardiological examinations, 1- and 3-week ECG-Holter will be performed in subpopulation of patients old up to 50 years and with cryptogenic ischemic stroke in the period from 1st May 2013 to 31st December 2015. These patients will also fill in a special epidemiologic questionnaire. Anticipated enrollment in this substudy of HISTORY study is 40 - 80 patients.

In selected young cryptogenic stroke patients, a subcutaneous cardiac monitor was implanted for the detection of paroxysmal atrial fibrillation in the period from 1st January 2014 to 31st December 2015.

From 2016 in young ischemic stroke (IS) patients under 50 years, a standard perfusion/ventilation scintigraphy of lungs will be performed to exclude acute pulmonary embolization (coincidental) in case of elevated serum D-dimers after admission.

In all enrolled young IS patients, a BP Holter will be performed after the discharge home to exclude possible arterial hypertension, which did not presented during hospitalization.

Eligibility criteria: Inclusion Criteria:

* Ischemic stroke admitted within 12 hours from stroke onset at stroke center

Exclusion Criteria:

* none

Primary outcomes:
measure: To assess the serum level profile of cardiac troponin T (cTnT) in acute ischemic stroke (AIS) patients and to evaluate factors associated with increased serum level of cTnT.
timeFrame: Within 12 hours after ischemic stroke onset.
Secondary outcomes:
measure: Correlation between location and volume of brain infarction.
timeFrame: At admission within 12 hours after stroke onset and after 24hours.
Other outcomes:
Locations:
city: Olomouc
country: Czechia
facility: University Hospital Olomouc
Study officials:
affiliation: University Hospital Olomouc
name: Michal Kral, MD
role: STUDY_DIRECTOR
References:
citation: Franc D, Sanak D, Divisova P, Lyskova L, Bartkova A, Zapletalova J, Kral M, Dornak T, Polidar P, Veverka T, Kanovsky P. Socioeconomic status and lifestyle in young ischaemic stroke patients: a possible relationship to stroke recovery and risk of recurrent event. Cent Eur J Public Health. 2021 Sep;29(3):223-229. doi: 10.21101/cejph.a6697.
citation: Divisova P, Sanak D, Vaclavik J, Kral M, Hutyra M, Zapletalova J, Bartkova A, Franc D, Dornak T, Veverka T, Taborsky M, Kanovsky P. Arterial Hypertension and Risk of Recurrent Event in Young Ischemic Stroke Patients. Can J Neurol Sci. 2021 May;48(3):358-364. doi: 10.1017/cjn.2020.200. Epub 2020 Sep 11.
citation: Divisova P, Sanak D, Kral M, Bartkova A, Hutyra M, Zapletalova J, Dornak T, Spacek M, Franc D, Polidar P, Veverka T, Kanovsky P. Young cryptogenic ischemic stroke: A descriptive analysis of clinical and laboratory characteristics, outcomes and stroke recurrence. J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105046. doi: 10.1016/j.jstrokecerebrovasdis.2020.105046. Epub 2020 Jun 23.
citation: Sanak D, Divisova P, Hutyra M, Kral M, Bartkova A, Zapletalova J, Latal J, Dornak T, Hudec S, Franc D, Polidar P, Veverka T, Kanovsky P. Risk of recurrent ischemic stroke in young cryptogenic patients with embolic stroke of undetermined source. J Neurol Sci. 2020 Sep 15;416:116985. doi: 10.1016/j.jns.2020.116985. Epub 2020 Jun 13.
citation: Sanak D, Hutyra M, Kral M, Bartkova A, Zapletalova J, Fedorco M, Veverka T, Vindis D, Dornak T, Skala T, Skoloudik D, Taborsky M, Kanovsky P. Paroxysmal atrial fibrillation in young cryptogenic ischemic stroke: A 3-week ECG Holter monitoring study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015 Jun;159(2):283-7. doi: 10.5507/bp.2015.019. Epub 2015 Apr 24.
citation: Sanak D, Hutyra M, Kral M, Bartkova A, Zapletalova J, Fedorco M, Veverka T, Vindis D, Dornak T, Skala T, Skoloudik D, Taborsky M, Kanovsky P. Atrial fibrillation in young ischemic stroke patients: an underestimated cause? Eur Neurol. 2015;73(3-4):158-63. doi: 10.1159/000369793. Epub 2015 Jan 8.
citation: Kral M, Sanak D, Veverka T, Hutyra M, Vindis D, Bartkova A, Kuncarova A, Dornak T, Cechakova E, Herzig R, Langova K, Kanovsky P, Skoloudik D. Troponin T: Correlation with location and volume of acute brain infarction. Int J Cardiol. 2015 Feb 15;181:127-32. doi: 10.1016/j.ijcard.2014.12.027. Epub 2014 Dec 3.
citation: Kral M, Skoloudik D, Sanak D, Veverka T, Bartkova A, Dornak T, Hutyra M, Vindis D, Ulehlova J, Slavik L, Svabova M, Kubickova V, Herzig R, Kanovsky P. Assessment of relationship between acute ischemic stroke and heart disease--protocol of a prospective observational trial. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2012 Sep;156(3):284-9. doi: 10.5507/bp.2012.094. Epub 2012 Oct 4.