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Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease: A Population-based MRI Study
BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) has been associated with cognitive decline and dementia. However, the mechanisms behind these associations are not clear. Examination of cerebrovascular pathology on MRI may shed light on how AF affects the brain. This study aimed to determine whet...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8548961/ https://www.ncbi.nlm.nih.gov/pubmed/34521692 http://dx.doi.org/10.1212/WNL.0000000000012675 |
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author | Rydén, Lina Sacuiu, Simona Wetterberg, Hanna Najar, Jenna Guo, Xinxin Kern, Silke Zettergren, Anna Shams, Sara Pereira, Joana B. Wahlund, Lars-Olof Westman, Eric Skoog, Ingmar |
author_facet | Rydén, Lina Sacuiu, Simona Wetterberg, Hanna Najar, Jenna Guo, Xinxin Kern, Silke Zettergren, Anna Shams, Sara Pereira, Joana B. Wahlund, Lars-Olof Westman, Eric Skoog, Ingmar |
author_sort | Rydén, Lina |
collection | PubMed |
description | BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) has been associated with cognitive decline and dementia. However, the mechanisms behind these associations are not clear. Examination of cerebrovascular pathology on MRI may shed light on how AF affects the brain. This study aimed to determine whether AF is associated with a broad range of cerebrovascular diseases beyond the well-known association with symptomatic stroke, including silent infarcts and markers of small vessel disease, i.e., cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and lacunes, in a population-based sample of 70-year-olds. METHODS: Data were obtained from the Gothenburg H70 Birth Cohort Studies, in which individuals are invited based on birthdate. This study has a cross-sectional design and includes individuals born in 1944 who underwent structural brain MRI in 2014 to 2017. AF diagnoses were based on self-report, ECG, and register data. Symptomatic stroke was based on self-report, proxy interviews, and register data. Brain infarcts and CMBs were assessed by a radiologist. WMH volumes were measured on fluid-attenuated inversion recovery images with the Lesion Segmentation Tool. Multivariable logistic regression was used to study the association between AF and infarcts/CMBs, and multivariable linear regression was used to study the association between AF and WMHs. RESULTS: A total of 776 individuals were included, and 65 (8.4%) had AF. AF was associated with symptomatic stroke (odds ratio [OR] 4.5, 95% confidence interval [CI] 2.1–9.5) and MRI findings of large infarcts (OR 5.0, 95% CI 1.5–15.9), lacunes (OR 2.7, 95% CI 1.2–5.6), and silent brain infarcts (OR 3.5; 95% CI 1.6–7.4). Among those with symptomatic stroke, individuals with AF had larger WMH volumes (0.0137 mL/total intracranial volume [TIV], 95% CI 0.0074–0.0252) compared to those without AF (0.0043 mL/TIV, 95% CI 0.0029–0.0064). There was no association between AF and WMH volumes among those without symptomatic stroke. In addition, AF was associated to CMBs in the frontal lobe. DISCUSSION: AF was associated with a broad range of cerebrovascular pathologies. Further research is needed to establish whether cerebrovascular MRI markers can be added to current treatment guidelines to further personalize anticoagulant treatment in patients with AF and to further characterize the pathogenetic processes underlying the associations between AF and cerebrovascular diseases, as well as dementia. |
format | Online Article Text |
id | pubmed-8548961 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-85489612021-10-31 Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease: A Population-based MRI Study Rydén, Lina Sacuiu, Simona Wetterberg, Hanna Najar, Jenna Guo, Xinxin Kern, Silke Zettergren, Anna Shams, Sara Pereira, Joana B. Wahlund, Lars-Olof Westman, Eric Skoog, Ingmar Neurology Research Article BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) has been associated with cognitive decline and dementia. However, the mechanisms behind these associations are not clear. Examination of cerebrovascular pathology on MRI may shed light on how AF affects the brain. This study aimed to determine whether AF is associated with a broad range of cerebrovascular diseases beyond the well-known association with symptomatic stroke, including silent infarcts and markers of small vessel disease, i.e., cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and lacunes, in a population-based sample of 70-year-olds. METHODS: Data were obtained from the Gothenburg H70 Birth Cohort Studies, in which individuals are invited based on birthdate. This study has a cross-sectional design and includes individuals born in 1944 who underwent structural brain MRI in 2014 to 2017. AF diagnoses were based on self-report, ECG, and register data. Symptomatic stroke was based on self-report, proxy interviews, and register data. Brain infarcts and CMBs were assessed by a radiologist. WMH volumes were measured on fluid-attenuated inversion recovery images with the Lesion Segmentation Tool. Multivariable logistic regression was used to study the association between AF and infarcts/CMBs, and multivariable linear regression was used to study the association between AF and WMHs. RESULTS: A total of 776 individuals were included, and 65 (8.4%) had AF. AF was associated with symptomatic stroke (odds ratio [OR] 4.5, 95% confidence interval [CI] 2.1–9.5) and MRI findings of large infarcts (OR 5.0, 95% CI 1.5–15.9), lacunes (OR 2.7, 95% CI 1.2–5.6), and silent brain infarcts (OR 3.5; 95% CI 1.6–7.4). Among those with symptomatic stroke, individuals with AF had larger WMH volumes (0.0137 mL/total intracranial volume [TIV], 95% CI 0.0074–0.0252) compared to those without AF (0.0043 mL/TIV, 95% CI 0.0029–0.0064). There was no association between AF and WMH volumes among those without symptomatic stroke. In addition, AF was associated to CMBs in the frontal lobe. DISCUSSION: AF was associated with a broad range of cerebrovascular pathologies. Further research is needed to establish whether cerebrovascular MRI markers can be added to current treatment guidelines to further personalize anticoagulant treatment in patients with AF and to further characterize the pathogenetic processes underlying the associations between AF and cerebrovascular diseases, as well as dementia. Lippincott Williams & Wilkins 2021-10-19 /pmc/articles/PMC8548961/ /pubmed/34521692 http://dx.doi.org/10.1212/WNL.0000000000012675 Text en Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Rydén, Lina Sacuiu, Simona Wetterberg, Hanna Najar, Jenna Guo, Xinxin Kern, Silke Zettergren, Anna Shams, Sara Pereira, Joana B. Wahlund, Lars-Olof Westman, Eric Skoog, Ingmar Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease: A Population-based MRI Study |
title | Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease: A Population-based MRI Study |
title_full | Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease: A Population-based MRI Study |
title_fullStr | Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease: A Population-based MRI Study |
title_full_unstemmed | Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease: A Population-based MRI Study |
title_short | Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease: A Population-based MRI Study |
title_sort | atrial fibrillation, stroke, and silent cerebrovascular disease: a population-based mri study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8548961/ https://www.ncbi.nlm.nih.gov/pubmed/34521692 http://dx.doi.org/10.1212/WNL.0000000000012675 |
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