Professor Wolfram Doehner, MD, PhD, FESC
Vice Chair of the ESC Council on Stroke and Professor at the Stroke Research Center, Charité Universitätsmedizin Berlin
Please introduce yourself and some important current research?
I am a cardiologist as well as specialist in internal medicine and nutritional medicine. My current research focus is the peripheral aspect, and particularly, the skeletal muscle structure and metabolism in stroke patients.
In patients with stroke, there is catabolic activation, degradation of muscle mass and impairment of muscle function. This occurs to not only the paralyzed limbs, but also at a systemic level, to the non-paralyzed limbs. Since the regaining of mobility and functional capacity greatly depends on the optimum muscle function of the remaining intact muscle, efforts should be taken to improve muscle function as much as possible. We are investigating these mechanisms, how the muscles are affected by stroke and how function can be improved.
You were co-author of the ESC position paper on the role of cardiologists in stroke prevention and treatment. What is the important message of this paper?
The modern, comprehensive treatment of stroke patients requires a collective/ interdisciplinary approach with joint forces of cardiologists and neurologists.
The ESC founded the Council on Stroke in 2016 to promote the concept that a more comprehensive treatment of stroke patients can only be achieved through greater collaboration, communication and coordination between cardiologists and neurologists.
The ESC position paper represents an important step forward, the positioning of the cardiologist in the treatment and diagnosis of stroke based on the latest understandings.
What is the ideal collaborative approach?
There should always be collaboration and mutual feedback between both specialties. This should start as early as the initial diagnostic work-up when the stroke patient arrives in the emergency department. For example, vital aspects such as heartbeat, heart rhythm and functions of the myocardium must be taken care of immediately.
Once initial stroke treatment by the neurologist has commenced in the stroke unit, there should be further collaboration with cardiologists to manage the many complications originating from the cardiovascular system. Specifically, this would address the interaction between brain injury and myocardial function. While cardiac function may be responsible for cerebral injury, there are also neuro-endocrine signaling pathways through which acute stroke may have a detrimental effect on cardiac function.
Are there any barriers holding back these collaborations?
There are no explicit barriers. However, the last decades have seen a process of increasing specialization within each medical field, leading to great advances and in-depth research and understanding of highly specific aspects. This has inevitably sometimes led to a narrowed perspective. Therefore, it is now important to regain a holistic perspective, above and beyond these specializations, and return to the broader task of treating not only the organ, but the whole patient.
Heart & Brain 2018 brings together the different specialties. What are you most looking forward to about this Symposium?
Within the ESC Council on Stroke, we aim for an inter-disciplinary approach to mutual cardiologic/ neurologic education. The Symposium itself is a prime example of how this can be successfully pursued: the collaboration, better interaction, and mutual education on stroke, where both brain injury and myocardiac aspects are involved. I'm very excited to participate in this format of meeting and be part of the model being pursued in the United States.
What is your vision for stroke treatment?
One of my visions is that stroke should be understood as a chronic disease.
Unfortunately, this is not yet the case. For example, patients with ischemic heart disease or with heart failure are always regarded as chronic patients with a heart issue and are referred to a cardiologist for their long-term care. The same is for other diseases, such as chronic kidney or lung diseases; these patients are viewed as chronic patients and receive follow-up by specialists in the chronic course of the disease. Likewise, it is important to understand stroke patients as chronic patients, who require specialized expertise and long-term monitoring and medical care. This implies a chronic cardiovascular attendance of risk profile, secondary prevention and cardiac work-up.
Download the full interview >
To read "The role of cardiologists in stroke prevention and treatment: position paper of the European Society of Cardiology Council on Stroke" click here
Petr Widimsky, Wolfram Doehner, Hans Christoph Diener, Isabelle C. Van Gelder, Alison Halliday, Mikael Mazighi; The role of cardiologists in stroke prevention and treatment: position paper of the European Society of Cardiology Council on Stroke, European Heart Journal, , ehx478
Professor Doehner will be delivering a Keynote lecture on The Heart Failure Patient with Stroke - What is Important, What is Different? and will also be participating in a panel discussion on Collaborative Medicine.
Check out the full program >