Risk factors and localization of silent cerebral infarction in patients with atrial fibrillation

Keita Miki; Makoto Nakano; Kentaro Aizawa; Yuhi Hasebe; Yoshitaka Kimura; Susumu Morosawa; Toshiaki Akashi; Yohei Morishita; Satoshi Miyata; Koji Fukuda; Hiroaki Shimokawa

doi:10.1016/j.hrthm.2019.03.013

Risk factors and localization of silent cerebral infarction in patients with atrial fibrillation

Heart Rhythm. 2019 Sep;16(9):1305-1313. doi: 10.1016/j.hrthm.2019.03.013. Epub 2019 Mar 18.

Authors

Affiliations

¹ Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: vdm@cardio.med.tohoku.ac.jp.
² Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
³ Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan.
⁴ Department of Cardiology, International University of Health and Welfare, Nasushiobara, Japan.

PMID: 30898584
DOI: 10.1016/j.hrthm.2019.03.013

Abstract

Background: It is important to identify the risk factors and localization of silent cerebral infarction (SCI), especially in younger patients with atrial fibrillation (AF).

Objective: The purpose of this study was to examine the characteristics and risk factors for SCI in AF patients, with particular attention to localization of SCI.

Methods: The study enrolled 286 consecutive neurologically asymptomatic patients who underwent AF ablation from January 2014 to July 2017 (age 61.7 ± 10.2 [SD] years; 208 male and 78 female). All patients underwent magnetic resonance imaging (MRI) before ablation.

Results: SCIs were classified independently by 2 radiologists as follows: cardiogenic SCI in 19 (10.6%), lacunar SCI in 13 (8.9%), undetermined causes in 6 (1.6%), and no SCI in 248 (controls, 78.7%). Importantly, no patients with CHA₂DS₂-VASc score 0 had SCI on MRI. In univariable analysis, significant risk factors for lacunar SCI included age (P = .007), hypertension (P = .037), congestive heart failure (P = .040), left atrial (LA) diameter (P = .013), and cardio-ankle vascular index (P = .004). In multivariable analysis, significant risk factors for cardiogenic SCI were AF duration (odds ratio [OR] 1.01; 95% confidence interval [CI] 1.00-1.02; P = .038), ankle-brachial pressure index (OR 0.002; 95% CI 0-0.68; P = .030), and LA abnormality (OR 8.99; 95% CI 2.78-31.00; P <.001), defined by the presence of spontaneous echo contrast and/or decreased LA appendage emptying velocity.

Conclusion: The study results indicate that among AF patients, SCIs localized in the cerebral cortex and cerebellum are frequently noted, for which cardiogenic mechanisms may be mainly involved; CHA₂DS₂-VASc score could be useful for screening SCI; and LA abnormality is the specific marker for cardiogenic SCI, providing useful information for risk stratification of SCI.

Keywords: Atrial fibrillation; Cardiogenic cerebral embolism; Cardiogenic cerebral infarction; Risk stratification; Silent cerebral infarction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Asymptomatic Diseases / epidemiology
Atrial Fibrillation* / complications
Atrial Fibrillation* / surgery
Catheter Ablation / methods
Catheter Ablation / statistics & numerical data*
Cerebral Infarction* / diagnostic imaging
Cerebral Infarction* / epidemiology
Cerebral Infarction* / etiology
Female
Humans
Japan / epidemiology
Magnetic Resonance Imaging* / methods
Magnetic Resonance Imaging* / statistics & numerical data
Male
Middle Aged
Outcome Assessment, Health Care
Risk Assessment
Risk Factors