Atrial Fibrillation and Brain Magnetic Resonance Imaging Abnormalities

Berman, Jeremy; Norby, Faye L.; Mosley, Thomas H.; Soliman, Elsayed Z.; Gottesman, Rebecca F.; Lutsey, Pamela L.; Alonso, Álvaro; Chen, Lin Y.

doi:10.1161/strokeaha.118.024143

Cited by 21 publications

(17 citation statements)

References 36 publications

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“…Our finding that the association between AF and WMHs disappeared after taking stroke and cardiovascular risk factors into account is in line with results from the Mayo Clinic Study of Aging 29 and the Atherosclerosis Risk in Communities Neurocognitive Study. 30 , 31 In addition, our finding that AF was not associated with WMHs in individuals without a history of stroke is in line with the Framingham offspring study 32 and the German AF Competence NETwork Study. 33 However, in our study, individuals with both AF and anticoagulant treatment had larger WMH volumes than individuals without AF after adjustments, including cardiovascular risk factors, heart disease, and symptomatic stroke, while individuals with AF but no anticoagulant treatment did not have larger WMH volumes than individuals without AF.…”

Section: Discussionsupporting

confidence: 86%

Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease

et al. 2021

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Background and Objectives:Atrial fibrillation (AF) has been associated with cognitive decline and dementia. However, the mechanisms behind these associations are not clear. Examination of cerebrovascular pathology on MRI may shed light on how AF affects the brain. This study aimed to determine whether AF is associated with a broad range of cerebrovascular diseases, beyond the well-known association with symptomatic stroke, including silent infarcts and markers of small vessel disease, e.g. cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and lacunes, in a population-based sample of 70-year-olds.Methods:Data were obtained from the Gothenburg H70 Birth Cohort Studies, where individuals are invited based on birth-date. This study has a cross-sectional design and includes individuals born 1944 who underwent structural brain MRI in 2014-17. AF diagnoses were based on self-report, EKG, and register data. Symptomatic stroke was based on self-report, proxy-interviews, and register data. Brain infarcts and CMBs were assessed by a radiologist. WMH volumes were measured on FLAIR images using the Lesion Segmentation Tool. Multivariate logistic regression was used to study the association between AF and infarcts/CMBs, and multivariate linear regression was used to study the association between AF and WMHs.Results:A total of 776 individuals were included and 65 (8.4%) had AF. AF was associated with symptomatic stroke (OR 4.5, 95% CI 2.1-9.5), and MRI findings of large infarcts (OR 5.0, 95% CI 1.5-15.9), lacunes (OR 2.7, 95% CI 1.2-5.6), and silent brain infarcts (OR 3.5; 95% CI 1.6-7.4). Among those with symptomatic stroke, individuals with AF had larger WMH volumes (0.0137 ml/total intracranial volume (TIV), 95% CI 0.0074-0.0252) compared to those without AF (0.0043 ml/TIV, 95% CI 0.0029-0.0064). There was no association between AF and WMH volumes among those without symptomatic stroke. In addition, AF was associated to CMBs in the frontal lobe.Discussion:AF was associated with broad range of cerebrovascular pathologies. Further research is needed to establish whether cerebrovascular MRI markers can be added to current treatment guidelines to further personalise anticoagulant treatment in AF patients and to further characterize the pathogenetic processes underlying the associations between AF and cerebrovascular diseases, as well as dementia.

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Section: Discussionsupporting

confidence: 86%

Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease

et al. 2021

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“…Incident AF is associated with structural changes in brain MRI, including worsened sulcal grade, larger ventricles, and subclinical cerebral infarctions. However, analyses from the ARIC and the Framingham Heart Study could not demonstrate any association between AF and WMHs or total brain volume after adjustment for vascular risk factors [ 39 , 47 , 49 ]. Notably, WMHs, attributed to small vessel disease and global cerebral hypoperfusion, were not associated with AF [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

PR interval duration is associated with the presence of white matter hyperintensities: Insights from the epidemiologic LIFE-Adult Study

et al. 2022

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Background PR interval prolongation is a preliminary stage of atrial cardiomyopathy which is considered as an intermediate phenotype for atrial fibrillation (AF). AF is a known risk factor for cerebrovascular adverse outcomes including stroke. Cerebral ischemia is one cause of white matter hyperintensities (WMHs), and cognitive dysfunction. Aim To analyze the relationship between PR interval and WMHs. Materials and methods We performed a cross-sectional analysis with individuals from the LIFE-Adult-Study (a population-based cohort study of randomly selected individuals from Leipzig, Germany) with available brain MRI and ECG. The Fazekas stages were used to quantify WMHs (0 = none; 1 = punctate foci; 2 = beginning confluence; 3 = large confluent areas). Stages 2–3 were defined as advanced WMHs. The PR interval was measured from resting 12-lead ECG. PR duration >200ms was defined as PR interval prolongation. We used a binary logistic regression for statistical analysis. We examined the relationship between MRI and ECG measures and adjusted them for clinical risk factors. Results We included 2464 individuals (age 59±15 years, 47% women) into analyses. The median PR interval was 160ms (interquartile range 143–179), and 319 (13%) individuals with advanced WMHs, were significantly older, had more cardiovascular comorbidities and risk factors compared to individuals without WMHs (all p<0.005). On univariable analysis, PR interval duration (OR 1.01, 95%CI 1.01–1.02, p≤0.001) and PR interval ≥160 ms (OR 2.1, 95%CI 1.6–2.7, p≤0.001) were associated with advanced WMHs. In multivariable analysis, while PR interval duration was not associated with WMHs in the whole cohort, individuals with PR ≥160ms had higher risk for WMHs. Conclusion PR interval duration is associated with advanced WMHs beside advanced age, hypertension, and history of stroke. Further research is needed to determine whether changes in PR interval indices are clinically relevant for changes in WMHs.

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“…Brain MRI was performed in participants of the ARIC study, where, according to a longitudinal analysis, those (3%) who developed AF (29/963 participants) had higher odds of increase in subclinical cerebral infarctions (OR: 3.08, 95% CI: 1.39-6.83), worsening sulcal grade (OR: 3.56, 95% CI: 1.04-12.2), and worsening ventricular grade (OR: 9.34, 95% CI: 1.24-70.2). 103 In cross-sectional analysis, those with AF (35/969 participants, 3.6%) had greater odds of higher sulcal (OR: 3.9, 95% CI: 1.7-9.1) and ventricular grade (OR: 2.4, 95% CI: 1.0-5.7) after multivariable adjustment and no difference in WMH or total brain volume. The authors concluded that AF is independently associated with higher subclinical cerebral infarctions and worsening sulcal and ventricular grade morphological changes associated with aging and dementia.…”

Section: Brain Imagingmentioning

confidence: 91%

Atrial Fibrillation and Cognitive Impairment: An Associated Burden or Burden by Association?

Manolis

Apostolopoulos

et al. 2020

Angiology

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Growing evidence suggests that atrial fibrillation (AF), in addition to its thromboembolic risk, is a risk factor for cognitive impairment (CI) via several pathways and mechanisms, further contributing to morbidity/mortality. Prior stroke is a contributor to CI, but AF is also associated with CI independently from prior stroke. Silent brain infarctions, microemboli and microbleeds, brain atrophy, cerebral hypoperfusion from widely fluctuating ventricular rates, altered hemostatic function, vascular oxidative stress, and inflammation may all exacerbate CI, particularly in patients with persistent/permanent rather than paroxysmal AF and with increased duration/burden of the arrhythmia. Brain magnetic resonance imaging is an important screening tool in eliciting and monitoring vascular and nonvascular lesions contributing to CI. Evidence is also emerging about the role of genetics in CI development. Anticoagulation and rhythm/rate control strategies may protect against CI preventing or slowing its progression or conversion to dementia, particularly at the early stages when CI may still be a treatable condition. Importantly, AF and CI share many common risk factors. Thus, screening for these 2 conditions and searching for and managing modifiable risk factors and potentially reversible causes for both AF and CI remains an important step toward prevention or amelioration of the impact incurred by these 2 conditions.

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Atrial Fibrillation and Brain Magnetic Resonance Imaging Abnormalities

Cited by 21 publications

References 36 publications

Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease

Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease

PR interval duration is associated with the presence of white matter hyperintensities: Insights from the epidemiologic LIFE-Adult Study

Atrial Fibrillation and Cognitive Impairment: An Associated Burden or Burden by Association?

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