Aurora Semerano, MD
European Stroke Organisation Conference
May 4-6, 2022
The European Society of Cardiology (ESC) – European Stroke Organization (ESO) Joint Symposium, chaired by Marta Rubiera (Spain) and Wolfram Döhner (Germany), was a special occasion at ESOC 2022 to discuss both the heart-brain interactions in stroke and the precious collaborations with our closest cousins, the cardiologists.
Theodoros Karapanayiotides (Greece) introduced the basics of POCUS (Point of Care Ultrasound), a handheld device for rapid ultrasound cardiac investigation that could become a useful additional instrument for stroke neurologists. In the busy hospital setting with limited daily slots for echocardiography, indeed, POCUS could represent an extension of physical examination, that can rapidly answer specific questions and help to establish the timing of subsequent diagnostics, before referring to the cardiology service for full cardiac investigation.
Jan Scheitz (Germany) discussed the significance of troponin T elevation in patients after stroke. Far from being a rare finding on routine blood tests, serial measurements are the key to distinguish between chronic and acute conditions of myocardial injury. Among acute conditions, all requiring timely investigations, the so-called “demand ischemia” (that’s to say ischemia primarily due to cardiac supply/demand imbalance rather than coronary artery disease) should always be taken into consideration in stroke patients.
Martin Köhrmann (Germany) focused on ECG monitoring in the Stroke Unit. A systematic and daily approach is suggested, to increase confidence with the great amount of data and get the most from continuous electrocardiographic monitoring. It is likely that advanced and intensified monitoring can detect atrial fibrillation more frequently and change therapeutic decisions. He also pointed out that it’s not all about atrial fibrillation: Other severe arrhythmias can be frequent and clinically relevant in the stroke population and need to be identified.
Magnus Bäck’s (Sweden) talk focused on cardiac and vascular thrombogenicity and its association with stroke risk. Far from being a mere electric condition, he pointed out that atrial fibrillation and inflammation team up in increasing embolic risk, suggested by the elevation of inflammatory byproducts and neutrophil-platelet aggregates in the blood and the thrombi of patients with cardioembolic stroke.
Jan Kovac (United Kingdom) emphasized the multidisciplinary nature of stroke medicine, requiring several new skills for all specialties and close cooperation between the different professional figures. He provided an overview on the current indications for cardiac interventions, such as closure of left atrial appendage, transcatheter ablation of atrial fibrillation and PFO closure, with special attention on the mechanisms of cerebral protection during cardiac procedures.