Ischemic brain infarcts, white matter hyperintensities, and cognitive impairment are increased in patients with Atrial Fibrillation.
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Krisai Philipp, Aeschbacher Stefanie, Coslovsky Michael, Rommers Nikki, Reichlin Tobias, Müller Andreas S, Beer Jürg H, Ammann Peter, Auricchio Angelo, Moschovitis Giorgio, Kobza Richard, Shah Dipen, Di Valentino Marcello, Conte Giulio, Ehret Georg, Hennings Elisa, Monsch Andreas, Paladini Rebecca E, Rodondi Nicolas, Roten Laurent, Schwenkglenks Matthias, Sticherling Christian, Badertscher Patrick, Zuern Christine S, Sinnecker Tim, Duering Marco, Mahfoud Felix, Bonati Leo H, Conen David, Osswald Stefan, Kühne Michael, eMBA, for the Swiss-AF Investigators
Аннотация
METHODS: We enrolled 1,480 patients with and 959 without AF in a multicenter prospective study (Swiss-AF; NCT02105844). We assessed brain structure, and cognition using the Montreal Cognitive Assessment (MoCA). Brain magnetic resonance imaging (MRI) was performed to assess large non-cortical and cortical infarcts (LNCCI), small non-cortical infarcts (SNCI), white matter hyperintensities (WMH), and microbleeds. Using causal mediation analyses, we investigated the direct (lesion-independent) and indirect (lesion-mediated) effects of AF on cognition.
RESULTS: Mean age in AF patients is 75.0 vs. 74.2 years in no-AF patients, 28.6% vs. 36.9% are female, and comorbidities are comparable. The prevalence of MRI-detected brain infarcts (LNCCI and/or SNCI) is 40.1% in AF patients vs. 24.0% in no-AF patients, adjusted OR (95% CI): 1.78 (1.30; 2.44), p = 0.0003. WMH (Fazekas ≥2) are more prevalent in AF patients (59.2% vs 44.4%), adjusted OR (95% CI): 2.03 (1.50; 2.77), p = 4.6e-06. The mean MoCA score is 25.3 in AF patients and 26.4 in no-AF patients. In mediation analysis, the total effect of AF on cognition is -1.05 MoCA points, decomposed into a direct effect of -0.99 and an indirect, lesion-mediated, effect of -0.06 points.
CONCLUSIONS: The prevalence of ischemic brain infarcts and WMH is higher in patients with AF than without AF despite comparable comorbidities. AF is associated with lower cognitive function, primarily through a direct effect rather than mediated by brain lesions.