May 10, 2022; 98 (19) Research Article
Prolonged Cardiac Monitoring and Stroke Recurrence
A Meta-analysis
Georgios Tsivgoulis, Sokratis Triantafyllou, Lina Palaiodimou, Brian Mac Grory, Spyridon Deftereos, Martin Köhrmann, View ORCID ProfilePolychronis Dilaveris, Brittany Ricci, Konstantinos Tsioufis, Shawna Cutting, View ORCID ProfileGkikas Magiorkinis, View ORCID ProfileChristos Krogias, Peter D. Schellinger, Efthymios Dardiotis, Ana Rodriguez-Campello, Elisa Cuadrado-Godia, View ORCID ProfileDiana Aguiar de Sousa, View ORCID ProfileMukul Sharma, David J. Gladstone, Tommaso Sanna, View ORCID ProfileRolf Wachter, Karen L. Furie, Andrei V. Alexandrov, Shadi Yaghi, Aristeidis H. Katsanos
First published March 9, 2022, DOI: https://doi.org/10.1212/WNL.0000000000200227
Georgios Tsivgoulis
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Sokratis Triantafyllou
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Lina Palaiodimou
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Brian Mac Grory
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Spyridon Deftereos
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Martin Köhrmann
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Polychronis Dilaveris
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Brittany Ricci
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Konstantinos Tsioufis
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Shawna Cutting
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Gkikas Magiorkinis
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Christos Krogias
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Peter D. Schellinger
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Efthymios Dardiotis
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Ana Rodriguez-Campello
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Elisa Cuadrado-Godia
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Diana Aguiar de Sousa
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Mukul Sharma
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
David J. Gladstone
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Tommaso Sanna
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Rolf Wachter
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Karen L. Furie
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Andrei V. Alexandrov
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Shadi Yaghi
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Aristeidis H. Katsanos
From the Second Department of Neurology (G.T., S.T., L.P., A.H.K.) and Second Department of Cardiology (S.D.), School of Medicine, “Attikon” Hospital, First Department of Cardiology (P.D., K.T.), School of Medicine, Hippokration Hospital, and Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Duke University School of Medicine (B.M.G.), Durham, NC; Department of Neurology (M.K.), Universitätsklinikum Essen, Germany; Department of Neurology (B.R., S.C., K.L.F.), Alpert Medical School, Brown University, Providence, RI; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University, Bochum; Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology (E.D.), University of Thessaly, Larissa, Greece; Stroke Unit (A.R.-C., E.C.-G.), Department of Neurology, Group of Research on Neurovascular Diseases, Hospital Del Mar Medical Research Institute. DCEX, Universitat Pompeu Fabra, Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Division of Neurology (M.S., A.H.K.), McMaster University and Population Health Research Institute, Hamilton; Sunnybrook Research Institute and Hurvitz Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Canada; Fondazione Policlinico Gemelli IRCCS (T.S.); Catholic University of the Sacred Heart (T.S.), Institute of Cardiology, Rome, Italy; Clinic and Policlinic for Cardiology (R.W.), University Hospital Leipzig, Germany; and Department of Neurology (S.Y.), New York University School of Medicine, NY.
Prolonged Cardiac Monitoring and Stroke Recurrence
A Meta-analysis
Georgios Tsivgoulis, Sokratis Triantafyllou, Lina Palaiodimou, Brian Mac Grory, Spyridon Deftereos, Martin Köhrmann, Polychronis Dilaveris, Brittany Ricci, Konstantinos Tsioufis, Shawna Cutting, Gkikas Magiorkinis, Christos Krogias, Peter D. Schellinger, Efthymios Dardiotis, Ana Rodriguez-Campello, Elisa Cuadrado-Godia, Diana Aguiar de Sousa, Mukul Sharma, David J. Gladstone, Tommaso Sanna, Rolf Wachter, Karen L. Furie, Andrei V. Alexandrov, Shadi Yaghi, Aristeidis H. Katsanos
Neurology May 2022, 98 (19) e1942-e1952; DOI: 10.1212/WNL.0000000000200227
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Abstract
Background and Objectives Prolonged poststroke cardiac rhythm monitoring (PCM) reveals a substantial proportion of patients with ischemic stroke (IS) with atrial fibrillation (AF) not detected by conventional rhythm monitoring strategies. We evaluated the association between PCM and the institution of stroke preventive strategies and stroke recurrence.
Methods We searched MEDLINE and SCOPUS databases to identify studies reporting stroke recurrence rates in patients with history of recent IS or TIA receiving PCM compared with patients receiving conventional cardiac rhythm monitoring. Pairwise meta-analyses were performed under the random effects model. To explore for differences between the monitoring strategies, we combined direct and indirect evidence for any given pair of monitoring devices assessed within a randomized controlled trial (RCT).
Results We included 8 studies (5 RCTs, 3 observational; 2,994 patients). Patients receiving PCM after their index event had a higher rate of AF detection and anticoagulant initiation in RCTs (risk ratio [RR] 3.91, 95% CI 2.54–6.03; RR 2.16, 95% CI 1.66–2.80, respectively) and observational studies (RR 2.06, 95% CI 1.57–2.70; RR 2.01, 95% CI 1.43–2.83, respectively). PCM was associated with a lower risk of recurrent stroke during follow-up in observational studies (RR 0.29, 95% CI 0.15–0.59), but not in RCTs (RR 0.72, 95% CI 0.49–1.07). In indirect analyses of RCTs, the likelihood of AF detection and anticoagulation initiation was higher for implantable loop recorders compared with Holter monitors and external loop recorders.
Discussion PCM after an IS or TIA can lead to higher rates of AF detection and anticoagulant initiation. There is no solid RCT evidence supporting that PCM may be associated with lower stroke recurrence risk.
Glossary
- AF=
- atrial fibrillation;
- AHA=
- American Heart Association;
- ASA=
- American Stroke Association;
- ESC=
- European Society of Cardiology;
- ESUS=
- embolic stroke of undetermined source;
- ICH=
- intracranial hemorrhage;
- ILR=
- implantable loop recorder;
- IS=
- ischemic stroke;
- NMA=
- network meta-analysis;
- PCM=
- poststroke cardiac rhythm monitoring;
- RCT=
- randomized controlled trial;
- RR=
- risk ratio;
- SUCRA=
- surface under the cumulative ranking
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 781
- Received October 6, 2021.
- Accepted in final form February 1, 2022.
- © 2022 American Academy of Neurology
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Letters: Rapid online correspondence
- Author Response: Prolonged Cardiac Monitoring and Stroke Recurrence: A Meta-analysis
- Georgios Tsivgoulis, Professor of Neurology, National and Kapodistrian University of Athens
- Aristeidis Katsanos, Assistant Professor of Neurology, McMaster University and Population Health Research Institute
Submitted March 27, 2022 - Author Response: Prolonged Cardiac Monitoring and Stroke Recurrence: A Meta-analysis
- Georgios Tsivgoulis, Professor of Neurology, National and Kapodistrian University of Athens
- Aristeidis Katsanos, Assistant Professor of Neurology, McMaster University and Population Health Research Institute
Submitted March 27, 2022 - Reader Response: Prolonged Cardiac Monitoring and Stroke Recurrence: A Meta-analysis
- Eugene L Scharf, Neurologist, Mayo Clinic
Submitted March 17, 2022 - Reader Response: Prolonged Cardiac Monitoring and Stroke Recurrence: A Meta-analysis
- Thomas Raphael Meinel, Vascular Neurologist, Stroke Research Center Bern
Submitted March 14, 2022
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