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; ... (2022). Silent brain infarcts impact on cognitive function in atrial fibrillation. European Heart Journal, 43(22), pp. 2127-2135. Oxford University Press 10.1093/eurheartj/ehac020
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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.
KEY QUESTION
The incidence of clinically overt and silent brain infarcts, white matter lesions, and microbleeds, and their impact on cognition in atrial fibrillation (AF) patients are not known.
KEY FINDING
Over 2 years of follow-up, 5.5% of AF patients developed new brain infarcts, with the majority of them being clinically silent and occurring in anticoagulated patients. New clinically overt and silent brain infarcts were similarly associated with cognitive decline.
TAKE-HOME MESSAGE
In a contemporary cohort of AF patients, new brain infarcts are frequent despite a high anticoagulation rate. Our data suggest that anticoagulation alone may not be sufficient to prevent brain damage and cognitive decline in all AF patients.
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