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Relationships of Overt and Silent Brain Lesions With Cognitive Function in Patients With Atrial Fibrillation

2019; Elsevier BV; Volume: 73; Issue: 9 Linguagem: Inglês

10.1016/j.jacc.2018.12.039

1558-3597

David Conen, Nicolas Rodondi, A. Müller, Jürg H. Beer, Peter Ammann, Giorgio Moschovitis, Angelo Auricchio, Daniel Hayoz, Richard Kobza, Dipen Shah, Ján Novák, Jürg Schläpfer, Marcello Di Valentino, Stefanie Aeschbacher, Steffen Blum, Pascal Meyre, Christian Sticherling, Leo H. Bonati, Georg Ehret, Elisavet Moutzouri, Urs Fischer, Andreas U. Monsch, Christoph Stippich, Jens Wuerfel, Tim Sinnecker, Michael Coslovsky, Matthias Schwenkglenks, Michael Kühne, Stefan Osswald, Sebastian Berger, Raffaele Bernasconi, L. Fröhlich, Tobias Göldi, Rebecca Gugganig, Thomas Kofler, Philipp Krisai, Michel Mongiat, Christiane Pudenz, Francisco Javier Ruperti‐Repilado, Aleksandra Schweizer, Anne Springer, Samuel Stempfel, Thomas D. Szucs, Jan van der Stouwe, Gian Voellmin, Leon Zwimpfer, Drahomir Aujesky, Juerg Fuhrer, Laurent Roten, Simon Jung, Heinrich P. Mattle, Luise Adam, Carole E. Aubert, Martin Feller, Claudio Schneider, Axel Loewe, Tanja Flückiger, Cindy Groen, Nathalie Schwab, Christopher Beynon, Roger Dillier, Franz R. Eberli, Simone Fontana, C Franzini, Isabel Juchli, Claudia Liedtke, Jacqueline Nadler, Thayze Obst, Xiaoye Schneider, Katrin Studerus, Dominik Weishaupt, Silke Küest, Karin Scheuch, Denise Hischier, Nicole R. Bonetti, Corina Bello, Henriette Isberg, Alexandra Grau, Jonas Villinger, Mary-Monica Papaux, Philipp Baumgartner, Mark G. Filipovic, Marcel Frick, Adriana Anesini, Cristina Camporini, Giulio Conte, Maria Luce Caputo, François Regoli, Tiziano Moccetti, Roman Brenner, David Altmann, Manuela Forrer, Michaela Gemperle, Mathieu Firmann, Sandrine Foucras, Benjamin Berte, Andrea Kaeppeli, Brigitta Mehmann, Markus Pfeiffer, Ian Russi, Kai Schmidt, Vanessa Weberndoerfer, Mabelle Young, Melanie Zbinden, Luisa Vicari, Jane Frangi, Tatiana Terrot, Hervé Gallet, Elise Guillermet, François Lazeyras, Karl‐Olof Lövblad, Patrick Perret, Cheryl Terés, Nathalie Lauriers, Marie Méan, Sandrine Salzmann, Nisha Arenja, Andrea Grêt, Sandra Vitelli, Jane Frangi, Augusto Gallino, Renate Schoenenberger-Berzins, Fabienne Witassek, Ernst‐Wilhelm Radue, Pascal Benkert, Thomas Fabbro, Patrick Simon, Ramun Schmid,

Acute Ischemic Stroke Management

Patients with atrial fibrillation (AF) have an increased risk of cognitive decline, potentially resulting from clinically unrecognized vascular brain lesions. This study sought to assess the relationships between cognitive function and vascular brain lesions in patients with AF. Patients with known AF were enrolled in a multicenter study in Switzerland. Brain magnetic resonance imaging (MRI) and cognitive testing using the Montreal Cognitive Assessment (MoCA) were performed in all participants. Large noncortical or cortical infarcts (LNCCIs), small noncortical infarcts (SNCIs), microbleeds, and white matter lesions were quantified by a central core laboratory. Clinically silent infarcts were defined as infarcts on brain MRI in patients without a clinical history of stroke or transient ischemic attack. The study included 1,737 patients with a mean age of 73 ± 8 years (28% women, 90% taking oral anticoagulant agents). On MRI, LNCCIs were found in 387 patients (22%), SNCIs in 368 (21%), microbleeds in 372 (22%), and white matter lesions in 1715 (99%). Clinically silent infarcts among the 1,390 patients without a history of stroke or transient ischemic attack were found in 201 patients with LNCCIs (15%) and 245 patients with SNCIs (18%). The MoCA score was 24.7 ± 3.3 in patients with and 25.8 ± 2.9 in those without LNCCIs on brain MRI (p < 0.001). The difference in MoCA score remained similar when only clinically silent LNCCIs were considered (24.9 ± 3.1 vs. 25.8 ± 2.9; p < 0.001). In a multivariable regression model including all vascular brain lesion parameters, LNCCI volume was the strongest predictor of a reduced MoCA (β = −0.26; 95% confidence interval: −0.40 to −0.13; p < 0.001). Patients with AF have a high burden of LNCCIs and other brain lesions on systematic brain MRI screening, and most of these lesions are clinically silent. LNCCIs were associated with worse cognitive function, even among patients with clinically silent infarcts. Our findings raise the question of MRI screening in patients with AF.