Silent brain infarcts impact on cognitive function in atrial fibrillation.
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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, Swiss-AF Investigators
Аннотация
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.