Prevalence and risk factors of silent brain infarcts in patients with AF detected by 3T-MRI

• Published in: Journal of neurology Vol. 267; no. 9; pp. 2675 - 2682
• Main Authors: Escudero-Martínez, Irene, Ocete, Rafael F., Mancha, Fernando, Vega, Ángela, Piñero, Pilar, López-Rueda, Antonio, Fajardo, Elena, Algaba, Pilar, Fernández-Engo, José Román, Martín-Sánchez, Eva M., Galvao-Carmona, Alejandro, Zapata-Arriaza, Elena, Lebrato, Lucía, Pardo-Galiana, Blanca, Cabezas, Juan Antonio, Ayuso, María Irene, González, Alejandro, Moniche, Francisco, Montaner, Joan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2020; Springer Nature B.V
• Subjects: Echocardiography; Enlargement; Fibrillation; Magnetic resonance imaging; Medical imaging; Medical records; Medicine; Medicine & Public Health; Neuroimaging; Neurology; Neuroradiology; Neurosciences; Original Communication; Patients; Risk factors; Stroke; Stroke; MRI; Silent brain infarction; Atrial fibrillation
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-020-09887-0

Background
Silent brain infarcts (SBI), a finding on neuroimaging, are associated with higher risk of future stroke. Atrial Fibrillation (AF) has been previously identified as a cause of SBI.
Objectives
The aim of this study is to determine the prevalence of and risk factors for SBI in patients with AF and low-to-moderate embolic risk according to CHADS
2
and CHA
2
DS
2
VASc score.
Methods
Patients with a history of AF based on medical records who scored 0–1 in the CHADS
2
score were selected from the Seville urban area using the Andalusian electronic healthcare database (DIRAYA). Demographic and clinical data were collected and a 3T brain MRI was performed on patients older than 50 years and with absence of neurological symptoms.
Results
66 of the initial 443 patients (14.9%) and 41 of the 349 patients with low risk according to CHA
2
DS
2
VASc score (11.7%) presented at least 1 SBI. After adjusted multivariable analysis, an older age (OR 3.84, 95% CI 1.07–13.76) and left atrial (LA) enlargement (OR 3.13, 95% CI 1.15–8.55) were associated with SBI in the whole cohort, while only LA enlargement was associated with SBI in the low-risk cohort (OR 3.19, 95% CI 1.33–7.63).
Conclusions
LA enlargement on echocardiogram was associated with SBI in patients with AF and low or moderate embolic risk according to CHADS
2
and in the low-risk population according to CHA
2
DS
2
VASc. Although further studies are needed, a neuroimaging screening might be justified in these patients to guide medical therapies to improve stroke prevention.