Silent brain infarcts impact on cognitive function in atrial fibrillation

Author:

Kühne Michael12ORCID,Krisai Philipp12ORCID,Coslovsky Michael23ORCID,Rodondi Nicolas45,Müller Andreas6ORCID,Beer Jürg H7,Ammann Peter8,Auricchio Angelo9ORCID,Moschovitis Giorgio10ORCID,Hayoz Daniel11,Kobza Richard12ORCID,Shah Dipen13ORCID,Stephan Frank Peter14,Schläpfer Jürg15,Di Valentino Marcello16ORCID,Aeschbacher Stefanie12ORCID,Ehret Georg13ORCID,Eken Ceylan12,Monsch Andreas17,Roten Laurent18ORCID,Schwenkglenks Matthias1920ORCID,Springer Anne12ORCID,Sticherling Christian12ORCID,Reichlin Tobias18ORCID,Zuern Christine S12,Meyre Pascal B12ORCID,Blum Steffen12ORCID,Sinnecker Tim2122,Würfel Jens22ORCID,Bonati Leo H.21ORCID,Conen David23ORCID,Osswald Stefan12ORCID,

Affiliation:

1. Cardiology/Electrophysiology Division, Department of Medicine, University Hospital Basel, University of Basel , Petersgraben 4, 4031 Basel , Switzerland

2. Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel , Basel , Switzerland

3. Clinical Trial Unit Basel, Department of Clinical Research, University Hospital Basel , Basel , Switzerland

4. Institute of Primary Health Care (BIHAM), University of Bern , Bern , Switzerland

5. Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland

6. Department of Cardiology, Triemli Hospital Zürich , Zürich , Switzerland

7. Department of Medicine, Conatonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich , Zürich , Switzerland

8. Department of Cardiology, Kantonsspital St Gallen , St Gallen , Switzerland

9. Division of Cardiology, Fondazione Cardiocentro Ticino , Lugano , Switzerland

10. Division of Cardiology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale , Lugano , Switzerland

11. Department of Internal Medicine, HRF—Hôpital Cantonal Fribourg , Fribourg , Switzerland

12. Department of Cardiology, Luzerner Kantonsspital , Lucerne , Switzerland

13. Division of Cardiology, Department of Medical Specialities, University Hospital Geneva , Geneva , Switzerland

14. Department of Cardiology, Bürgerspital Solothurn , Solothurn , Switzerland

15. Department of Cardiology, Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland

16. Division of Cardiology, Ospedale San Giovanni, Ente Ospedaliero Cantonale , Bellinzona , Switzerland

17. Memory Clinic, Universitäre Altersmedizin, Felix Platter Spital Basel, University of Basel , Basel , Switzerland

18. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland

19. Epidemiology, Biostatistics, and Prevention Institute, University of Zürich , Zürich , Switzerland

20. Institute of Pharmaceutical Medicine (ECPM), University of Basel , Basel , Switzerland

21. Department of Neurology and Stroke Center, University Hospital Basel, University of Basel , Basel , Switzerland

22. Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, Univesity of Basel , Basel , Switzerland

23. Population Health Research Institute, McMaster University , 237 Barton Street East, Hamilton, ON , Canada L8L 2X2

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

Funder

Swiss National Science Foundation

Swiss Heart Foundation

Foundation for Cardiovascular Research Basel

University of Basel

McMaster University

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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