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Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO): echocardiography performance protocol

Echo Research & Practice volume 6, pages 53–61 (2019)Cite this article

Abstract

Background The incidence of ischemic stroke in young patients is increasing and associated with unfavorable prognosis due to high risk of recurrent cardiovascular events. In many young patients the cause of stroke remains unknown, referred to as cryptogenic stroke. Neuroimaging frequently suggests a proximal source of embolism in these strokes. We developed a comprehensive step-by-step echocardiography protocol for a prospective study with centralized reading to characterize preclinical cardiac changes associated with cryptogenic stroke.

Methods and study design

SECRETO (Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome; NCT01934725) is an ongoing multicenter case–control study enrolling patients (target n = 600) aged 18–49 years hospitalized due to first-ever ischemic stroke of undetermined etiology and age- and sex-matched controls (target n = 600). A comprehensive assessment of cardiovascular risk factors and extensive cardiac imaging with transthoracic and transesophageal echocardiography, electrocardiography and neurovascular imaging is performed. Transthoracic and transesophageal echocardiograms will be centrally read, following an extensive protocol particularly emphasizing the characteristics of left atrium, left atrial appendage and interatrial septum.

Conclusions A detailed assessment of both conventional and unconventional vascular risk factors and cardiac imaging with transthoracic and transesophageal echocardiography are implemented in SECRETO, aiming to establish indirect and direct risk factors and causes for cryptogenic stroke and novel pathophysiological brain–heart pathways. This may ultimately enable more personalized therapeutic options for these patients.

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Funding

The participating centers are funded by Finnish Medical Foundation, the Academy of Finland and Helsinki University Central Hospital.

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Authors and Affiliations

  1. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway

    Sahrai Saeed MD & Eva Gerdts MD

  2. Department of Clinical Science, University of Bergen, Bergen, Norway

    Eva Gerdts MD

  3. Department of Neurology, Haukeland University Hospital, Bergen, Norway

    Ulrike Waje-Andreassen MD

  4. Department of Cardiology, Heart and Lung Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

    Juha Sinisalo MD

  5. Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

    Jukka Putaala MD

Authors
  1. Sahrai Saeed MD
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  2. Eva Gerdts MD
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  3. Ulrike Waje-Andreassen MD
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  4. Juha Sinisalo MD
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  5. Jukka Putaala MD
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Correspondence to Sahrai Saeed MD.

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Saeed, S., Gerdts, E., Waje-Andreassen, U. et al. Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO): echocardiography performance protocol. Echo Res Pract 6, 53–61 (2019). https://doi.org/10.1530/ERP-19-0025

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  • DOI: https://doi.org/10.1530/ERP-19-0025

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Echo Research & Practice

ISSN: 2055-0464

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