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, F. Stephan, Jürg Schläpfer, Marcello Di Valentino, Stefanie Aeschbacher, Georg Ehret, Ceylan Eken, Andreas U. Monsch, Laurent Roten, Matthias Schwenkglenks, Anne Springer, Christian Sticherling, Tobias Reichlin, Christine S. Zuern, Pascal Meyre, Steffen Blum, Tim Sinnecker, Jens Würfel, Leo H. Bonati, David Conen, Stefan Osswald, for the 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://clinicaltrials.gov/ct2/show/NCT02105844.