The Greifswald Heart and Brain Project: Coronary and Cerebral Microvascular Dysfunction in Patients With Acute Neurological Diseases

Neurological and cardiovascular diseases are increasing in relative and absolute terms globally, and pose a major burden in terms of morbidity, mortality, quality of life and healthcare costs. Increasing evidence that microvascular dysfunction of the heart and the brain share similar disease risk factors as well as underlying pathophysiological mechanisms has been found but evidence about the potential link between both pathological processes is scarce.

This observational study will investigate whether in patients with acute neurological diseases (i.e., first-time acute stroke, first-time generalized epileptic seizure, or transient global amnesia [TGA]) without clinical evidence of acute coronary syndrome, microvascular dysfunction is found in the brain and in the heart within 72 hours (for TGA 24-72 hours) after onset of first symptoms.

A total of 60 in-patients who were referred to hospital due to an acute neurological disease including acute first-time stroke (ischemic or hemorrhage; N = 20), first-time generalized epileptic seizure (with focal or generalized onset; N = 20) and TGA (N = 20), will be included in the study. In parallel, two control groups of 20 individuals each will be recruited from data repositories of young and older participants without pre-existing neurological disease who had agreed to be re-contacted for future studies. One control group will match the patient group with acute first-time stroke in terms of age, sex, hypertension, diabetes and smoking. The other control group will match the patient groups with acute first-time generalized epileptic seizure and TGA in terms of age and sex.

Participants will be found in the University Medicine Greifswald, Department of Neurology, admitted to hospital due to an acute neurological event (i.e., first-time acute stroke, first-time generalized epileptic seizure, or TGA). The G-HeBra study team from Neurology will check daily with the Neurologist on call for new hospitalizations due to the aforementioned acute neurological events and those patients will be visited as soon as possible by the G-HeBra study team; to be informed about the study. The G-HeBra study team will ascertain inclusion and exclusion criteria with the patient. If the patient is suitable and willing to participate in the study after receiving both oral and written information, the patient will sign the informed consent. After giving written informed consent, an identification number will be assigned for pseudonymization. Informed consent may be revoked at any time without any reason.

Appointments for the different study assessments will be made within 72 hours (for TGA after 24 hours up to 72 hours) after onset of first symptoms. The collection of demographic data, neuropsychological tests, questionnaires and a standardized medical examination including blood sampling will be conducted during the same visit, if possible. Further visits will be scheduled for cerebral and cardiac magnetic resonance imaging (MRI), transthoracic echocardiography (TTE) with strain, measurement of microvascular endothelial function, and angiography-derived assessment of coronary microvascular function. All assessments will be conducted as early as possible after the acute neurological event.