Silent brain infarcts impact on cognitive function in atrial fibrillation

Michael Kühne, Philipp Krisai, Michael Coslovsky, Nicolas Rodondi, Andreas Müller, Jürg H Beer, Peter Ammann, Angelo Auricchio, Giorgio Moschovitis, Daniel Hayoz, Richard Kobza, Dipen Shah, Frank Peter Stephan, Jürg Schläpfer, Marcello Di Valentino, Stefanie Aeschbacher, Georg Ehret, Ceylan Eken, Andreas Monsch, Laurent Roten, Matthias Schwenkglenks, Anne Springer, Christian Sticherling, Tobias Reichlin, Christine S Zuern, Pascal B Meyre, Steffen Blum, Tim Sinnecker, Jens Würfel, Leo H Bonati, David Conen, Stefan Osswald, Swiss-AF Investigators, Michael Kühne, Philipp Krisai, Michael Coslovsky, Nicolas Rodondi, Andreas Müller, Jürg H Beer, Peter Ammann, Angelo Auricchio, Giorgio Moschovitis, Daniel Hayoz, Richard Kobza, Dipen Shah, Frank Peter Stephan, Jürg Schläpfer, Marcello Di Valentino, Stefanie Aeschbacher, Georg Ehret, Ceylan Eken, Andreas Monsch, Laurent Roten, Matthias Schwenkglenks, Anne Springer, Christian Sticherling, Tobias Reichlin, Christine S Zuern, Pascal B Meyre, Steffen Blum, Tim Sinnecker, Jens Würfel, Leo H Bonati, David Conen, Stefan Osswald, Swiss-AF Investigators

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://ichgcp.net/clinical-trials-registry/NCT02105844.

Keywords: Atrial fibrillation; Brain infarction; Cognitive function; Magnetic resonance imaging; Oral anticoagulation.

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.

Figures

Structured Graphical Abstract
Structured Graphical Abstract
Brain damage and change in cognitive function in patients with atrial fibrillation.
Figure 1
Figure 1
Change in cognitive scores between baseline and second-year follow-up in patients with or without large non-cortical or cortical infarcts or small non-cortical infarcts identified at second-year follow-up. Boxes contain the 25 through 75% quartiles (spanning the interquartile range), the thick horizontal line is the median and the red crosses show the means. Whiskers indicate the most extreme values lying within the box-edge and 1.5 × the interquartile range. All eventual further values are plotted as individual points. CoCo, Cognitive Construct score; DSST, Digit Symbol Substitution Test; FUP, follow-up; LNCCI, large non-cortical and cortical infarcts; MoCA, Montreal Cognitive Assessment; SFT, Semantic Fluency Test; SNCI, small non-cortical infarcts; TMT, Trail Making Test.
Figure 2
Figure 2
Linear regression model for the change (Δscore) in the Cognitive Construct score for patients with 2-year follow-up data (n = 1139). LNCCI, large non-cortical and cortical infarcts; SNCI, small non-cortical infarcts.

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