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

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Abstract

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 CHADS2 and CHA2DS2VASc score.

Methods

Patients with a history of AF based on medical records who scored 0–1 in the CHADS2 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 CHA2DS2VASc 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 CHADS2 and in the low-risk population according to CHA2DS2VASc. Although further studies are needed, a neuroimaging screening might be justified in these patients to guide medical therapies to improve stroke prevention.

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Abbreviations

AF:

Atrial Fibrillation

CHADS:

Congestive heart failure, Hypertension, Age (≥ 75), Diabetes mellitus, Stroke/TIA

CHA2D2S-VASc:

Congestive heart failure, Hypertension, Age (≥ 75), Diabetes mellitus, Stroke/TIA, Vascular disease, Age 65–74, Sex category

HAS-BLED:

Hypertension, Abnormal renal and liver function, Stroke (1 point), Bleeding history or predisposition, Labile INR, Elderly (> 65 years), Drugs and Alcohol.

MRI:

Magnetic Resonance Imaging

NVAF:

Non-Valvular Atrial Fibrillation

SBI:

Silent Brain Infarct

TTE:

Transthoracic Echocardiography

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Acknowledgements

We would like to thank our MRI technicians for their work and Mar Díez from Fundación Cajasol for her interest in the project.

Funding

The Spanish Ministry of Economy, Industry and Competitiveness (Grant RTC-2016-5300-1), the Junta de Andalucía (Grant PIN-0144-2016) and the European Project ITRIBIS supported the study. The Fundación Cajasol also contributed to the study. Neurovascular Research Group is part of the Spanish Neurovascular Disease Research Network (INVICTUS + , RD16/0019/0015).

Author information

Authors and Affiliations

  1. Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain

    Irene Escudero-Martínez, Lucía Lebrato, Blanca Pardo-Galiana, Juan Antonio Cabezas & Francisco Moniche

  2. Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain

    Irene Escudero-Martínez, Rafael F. Ocete, Fernando Mancha, Ángela Vega, Pilar Algaba, Elena Zapata-Arriaza, Lucía Lebrato, Blanca Pardo-Galiana, Juan Antonio Cabezas, María Irene Ayuso, Alejandro González, Francisco Moniche & Joan Montaner

  3. Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain

    Rafael F. Ocete, Pilar Piñero, Elena Fajardo, Elena Zapata-Arriaza & Alejandro González

  4. Department of Radiology, Hospital Clínic, Barcelona, Spain

    Antonio López-Rueda

  5. IT Department, Andalusian Healthcare System, Seville, Spain

    José Román Fernández-Engo

  6. Information Systems Coordination Service, Andalusian Healthcare System, Seville, Spain

    Eva M. Martín-Sánchez

  7. Department of Psychology, Universidad Loyola Andalucía, Seville, Spain

    Alejandro Galvao-Carmona

  8. Department of Neurology, Hospital Universitario Virgen Macarena, Avenida Doctor Fedriani, No. 3, 41007, Seville, Spain

    Joan Montaner

Authors
  1. Irene Escudero-Martínez
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  2. Rafael F. Ocete
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  3. Fernando Mancha
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  4. Ángela Vega
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  6. Antonio López-Rueda
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  9. José Román Fernández-Engo
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  10. Eva M. Martín-Sánchez
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  14. Blanca Pardo-Galiana
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  15. Juan Antonio Cabezas
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  16. María Irene Ayuso
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  17. Alejandro González
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  18. Francisco Moniche
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  19. Joan Montaner
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Corresponding author

Correspondence to Joan Montaner.

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Conflicts of interest

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Ethical standard

The study protocol and consent forms were approved by the Ethics Committee of Virgen del Rocío University Hospital (reference no. 2014PI/162-1), and all participants gave written informed consent.

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Escudero-Martínez, I., Ocete, R.F., Mancha, F. et al. Prevalence and risk factors of silent brain infarcts in patients with AF detected by 3T-MRI. J Neurol 267, 2675–2682 (2020). https://doi.org/10.1007/s00415-020-09887-0

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  • DOI: https://doi.org/10.1007/s00415-020-09887-0

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