Silent brain infarcts impact on cognitive function in atrial fibrillation. (17th February 2022)

• Record Type: Journal Article
• Authors: Kühne, Michael; Krisai, Philipp; Coslovsky, Michael; Rodondi, Nicolas; Müller, Andreas; Beer, Jürg H; Ammann, Peter; Auricchio, Angelo; Moschovitis, Giorgio; Hayoz, Daniel; Kobza, Richard; Shah, Dipen; Stephan, Frank Peter; Schläpfer, Jürg; Di Valentino, Marcello; Aeschbacher, Stefanie; Ehret, Georg; Eken, Ceylan; Monsch, Andreas; Roten, Laurent; Schwenkglenks, Matthias; Springer, Anne; Sticherling, Christian; Reichlin, Tobias; Zuern, Christine S; Meyre, Pascal B; Blum, Steffen; Sinnecker, Tim; Würfel, Jens; Bonati, Leo H.; Conen, David; Osswald, Stefan;
• Is Part Of: European heart journal. Volume 43:Number 22(2022)
• Page Start: 2127
• Page End: 2135
• Publication Date: 2022-02-17
• Subjects: Atrial fibrillation -- Cognitive function -- Brain infarction -- Oral anticoagulation -- Magnetic resonance imaging; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehac020
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: We aimed to investigate the association of clinically overt and silent brain lesions with cognitive function in atrial fibrillation (AF) patients. Methods and results: We enrolled 1227 AF patients in a prospective, multicentre cohort study (Swiss-AF). Patients underwent standardized brain magnetic resonance imaging (MRI) at baseline and after 2 years. We quantified new small non-cortical infarcts (SNCIs) and large non-cortical or cortical infarcts (LNCCIs), white matter lesions (WML), and microbleeds (Mb). Clinically, silent infarcts were defined as new SNCI/LNCCI on follow-up MRI in patients without a clinical stroke or transient ischaemic attack (TIA) during follow-up. Cognition was assessed using validated tests. The mean age was 71 years, 26.1% were females, and 89.9% were anticoagulated. Twenty-eight patients (2.3%) experienced a stroke/TIA during 2 years of follow-up. Of the 68 (5.5%) patients with ≥1 SNCI/LNCCI, 60 (88.2%) were anticoagulated at baseline and 58 (85.3%) had a silent infarct. Patients with brain infarcts had a larger decline in cognition [median (interquartile range)] changes in Cognitive Construct score [−0.12 (−0.22; −0.07)] than patients without new brain infarcts [0.07 (−0.09; 0.25)]. New WML or Mb were not associated with cognitive decline. Conclusion: In a contemporary cohort of AF patients, 5.5% had a new brain infarct on MRI after 2 years. The majority of these infarcts was clinically silent and occurred in anticoagulated patients. Clinically, overt and silent brain infarcts had a similar impact on cognitive decline. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02105844, https://clinicaltrials.gov/ct2/show/NCT02105844 Structured Graphical Abstract: Structured Graphical Abstract Brain damage and change in cognitive function in patients with atrial fibrillation.