Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): German Ministry of Research and Education within the Comprehensive Heart Failure Centre Würzburg OnBehalf CV-CortEx Background Endogenous Cushing’s syndrome (CS) results in increased cardiovascular morbidity and mortality. This risk seems to be lower in patients with incidentally discovered mild autonomous cortisol secretion (MACS) but without the clinical features of CS. We aimed to describe and compare the cardiac morphology and function in patients with overt CS and MACS to a representative sample of a local prospective population-based cohort (STAAB). Methods/Results: We comprehensively characterized 40 patients with overt CS (mean age 47 ± 13 years, 75% women) and 18 patients with MACS (62 ± 11 years, 56% women; both p ≤ 0.001 when compared to CS) including detailed transthoracic echocardiography. Logistic regression adjusted for age and sex showed no significant differences between both groups regarding body mass index (BMI), systolic and diastolic blood pressure (BP), lipids, HbA1c, and echocardiographic parameters of cardiac morphology and function (table). The comparison with STAAB participants (n = 4965, 55 ± 12 years, 52% women; logistic regression adjusted for age and sex) revealed significantly higher BMI, triglycerides, HbA1c, and diastolic but not systolic BP (table). Compared to STAAB participants, patients exhibited a smaller left ventricle (LV) with thicker septal and posterior walls, and a less favorable diastolic function. LV ejection fraction (LVEF) was higher, although longitudinal contraction, measured by tricuspid annular plane systolic excursion (TAPSE), and LV global longitudinal strain (GLS) were lower in both ventricles compared to STAAB participants (table). Conclusion Patients with both MACS or CS exhibited a compromised metabolic profile and diastolic function pattern when compared to a population-based cohort. Higher LVEF despite lower GLS suggests a compensatory increase in LV radial contraction in states of hypercortisolism. Cardiac impairment was similar in patients with CS or MACS suggesting an adverse effect of hypercortisolism even at clinically inconspicuous levels. Abstract Figure.

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Ministry of Research and Education within the Comprehensive Heart Failure Center, Würzburg OnBehalf STAAB Cohort Study and CV-CORT-EX Study Background Endogenous Cushing’s syndrome (CS) is associated with increased cardiovascular morbidity and mortality. Long-term remission (LTR) after successful treatment is considered to positively affect the cardiovascular system including the heart. Left ventricular (LV) myocardial work (MyW) based on pressure-strain loops is a novel tool to non-invasively assess LV performance and is considered less load-dependent than LV ejection fraction (LVEF) and global longitudinal strain (GLS). We analyzed LV function in patients with overt CS and CS in LTR in comparison to healthy individuals derived from a local population-based cohort. Methods/Results: In a cross-sectional analysis, we compared n = 31 comprehensively characterized patients with overt CS (mean age 48 ± 12 years, 71% women) and 49 patients with CS in LTR (53 ± 12 years, 77% women) with a control group who underwent transthoracic echocardiography. As control group, we analyzed a population-based sample of apparently healthy individuals (in sinus rhythm, free from CV risk factors, and no significant valve disease) from a population-based cohort: n = 439, 49 ± 11 years, 56% women. MyW assessment was performed off-line using EchoPAC (GE, version 202). Systolic and diastolic blood pressure, HbA1c, and body mass index were significantly higher in patients with either overt CS or CS in LTR when compared to healthy participants (without significant differences between both patient groups). LVEF was equal between all three groups, but GLS was significantly lower in healthy participants and tended to be lower in LTR when compared to patients with CS. Global work index was equal between all three groups, but global wasted work was significantly higher in CS patients when compared to healthy participants, resulting in lower global work efficiency (Table). Conclusion In contrast to LVEF as established parameter of cardiac function, myocardial work analysis revealed functional alterations in patients with current and previous cortisol excess when compared to healthy individuals derived from a population-based sample. CS patients´ hearts appear to perform larger amounts of wasted work even during long-term remission. Abstract Figure.

Autonome Dysregulation (AD) ist ein wichtiger Pathomechanismus für kardiale Komplikation nach ischämischem Schlaganfall (IS). Der Orthostasetest (OT) wird häufig zur Objektivierung der autonomen Kreislaufregulation verwendet. Es liegen keine Daten zur Anwendung des OT bei Patienten mit akutem IS vor.

Decisions about taking antihypertensive medication as prescribed are likely to be influenced by patients' beliefs about medication. We assessed the influence of selected patient beliefs about medication on blood pressure (RR) control in subjects treated for arterial hypertension.

Studies investigating recent time trends in stroke mortality for different subtypes are scarce. We describe sex and age-standardized trends in stroke mortality for different stroke subtypes in Germany from 1998 – 2014 and potential regional variations.

Background and objective: Stroke is one of the leading causes for death and disability worldwide. A better understanding of the perception of modifiable stroke risk factors in the population is the first step to initiate effective prevention strategies on population level. Changes over 5 years in the risk perception in the general population were investigated by two representative surveys in Germany.Methods: Nationwide programs to screen voluntary participants for stroke risk were undertaken in 1995-1996 and 2000-2001 by the German Stroke Foundation, in cooperation with the health insurance company BARMER and the Sanofi-Synthelabo Company. As part of these programmes two surveys were performed by TNS-EM-NID to collect data on population knowledge. A representative sample of the German population was selected and asked to categorize their perception of stroke risk for common vascular risk factors.Results: A total of 8193 participants were interviewed (4081 in 1995-1996 and 4112 in 2000-2001); 43.5% were >= 50 years of age and 52.5% were female. Hypertension was rated by 68.3% to be in the highest risk category for stroke, followed by smoking (52.3%), hypercholesterolemia (48.0%), overweight (48.0%), excessive alcohol consumption (32.9%) and diabetes (26.6%). The proportion of participants who graded these factors to be important for stroke occurrence was persistently higher in 2000-2001 than in 1995-1996.Conclusion: Perception of modifiable risk factors for stroke increased over a 5-year time period in two representative surveys in Germany. The importance of diabetes mellitus as a risk factor for stroke is especially underestimated in the general population.

Predictors for in-hospital mortality and attributable risks of death were investigated in a large cohort of ischemic stroke patients from 104 academic and community hospitals across Germany. The effects of comorbidities on risk of in-hospital death were investigated. Death rates attributed to medical and neurological complications were calculated for patients exposed to complications as well as for the entire stroke population.

BACKGROUND AND PURPOSE:In Germany, data about variations in acute stroke treatment between different facilities are lacking. The aim of the present study was to compare the extent of diagnostic procedures for acute stroke between departments of neurology, internal medicine, and geriatric medicine.METHODS:Stroke patients admitted to hospitals cooperating within the Westphalian Stroke Register between January 1, 2000 and December 31, 2001 were analyzed. Forty-two hospitals participated in the study including 24 departments of neurology, 13 of internal medicine, and 5 of geriatric medicine. The register is based on a standardized data assessment including sociodemographic and clinical characteristics of the patient, in the acute phase, as well as diagnostic and treatment procedures, complications, and status at discharge. The performance of brain imaging, Doppler, and echocardiography was defined as diagnostic standard for diagnosis and etiological classification of ischemic stroke.RESULTS:A total of 12,232 stroke patients were included. Mean age was 72 years, 49 % were men. In general, diagnostic procedures were administered more often in neurological departments compared to departments of internal or geriatric medicine. In all participating hospitals, the application of diagnostic techniques was less frequent in older patients. The defined diagnostic standard was performed more often in those neurological departments providing acute stroke unit services compared to neurological departments without stroke unit services.CONCLUSION:Our study detected variations in the extent of diagnostic procedures in acute stroke between different medical disciplines. However, further studies are required to clarify whether a more frequent performance of diagnostic techniques yields relevant therapeutic consequences.

The objective was to determine the functional outcome, location of care and economic consequences in the first 3 months after ischemic stroke. As part of the Erlangen Stroke Project, (ESPro) information was collected on patients suffering a first‐ever ischemic stroke. Three months after the stroke, location of care, dependence on caregivers and function based on Barthel Index: poor (0–55), moderate (60–90) or good function (95–100) were recorded. Data about health services used were combined with cost estimates for Germany (€2000 Euros, undiscounted). Of 491 patients hospitalized, 383 were alive 3 months afterwards, 79% residing in the community. The majority of patients with poor function (60%) were still in institutional care. Patients with good function typically accrued the lowest costs, whether in an institution (€17 965) or not (€11 032) compared with poorer function who were living in an institution (poor: €26 370; moderate: €28,121), or community (poor: €27,207; moderate: €19,350). Hospitalization and rehabilitation services were the major costs accrued at each level of function. Many patients were left requiring a substantial amount of care and the costs associated with providing institutional care has a major impact on the economic consequences of a stroke.

Hintergrund: In Deutschland gibt es nur wenige Studien, die die Durchführung einer intravenösen Thrombolyse beim Hirninfarkt im klinischen Alltag dokumentieren. Zudem fehlen Daten über mögliche zeitliche Veränderungen der Lysebehandlung. Deshalb wurden im Rahmen der ADSR Datenpoolung Einflussfaktoren auf die Durchführung der Lyse sowie zeitliche Veränderungen in der Anwendung der Lysetherapie untersucht.

BACKGROUND:In Germany up-to-date data within community settings about factors influencing length of stay in acute hospitals are lacking. We, therefore, identified predictors for length of stay in acute hospital after ischemic stroke in a pooled analysis of large German stroke registers.METHODS:Ischemic stroke patients admitted to hospitals cooperating within the German Stroke Registers Study Group (ADSR) between January 1, 2000 and December 31, 2000 were analysed. The influence of patients' demographic and clinical characteristics as well as the characteristics of the treating hospitals on length of stay were analysed by multivariate linear regression.RESULTS:Overall, 13 440 patients after ischemic stroke were included in the analyses. Their mean age was 70 years, 53 % were men. Median length of stay in acute hospitals was 12 days. In multivariate analyses younger age, an increasing number of co-morbidities, and an increasing number of neurological deficits were identified as predictors of prolonged stay in hospital. Patients were more likely to stay longer in an acute hospital if they were to be discharged to a rehabilitation unit or to a nursing home. Length of stay was independently decreased for patients treated in hospitals providing acute stroke unit services and for hospitals treating more than 250 stroke patients per year.CONCLUSION:In addition to patients' demographic and clinical characteristics, length of stay in hospital was influenced by the hospitals' characteristics. Especially the volume of treated patients and the organisation of services within the hospital may play the key role.