. 2022 Jun 6;43(22):2127-2135.

doi: 10.1093/eurheartj/ehac020.

Silent brain infarcts impact on cognitive function in atrial fibrillation

Michael Kühne^{1

2}, Philipp Krisai^{1

2}, Michael Coslovsky^{2

3}, Nicolas Rodondi^{4

5}, Andreas Müller⁶, Jürg H Beer⁷, Peter Ammann⁸, Angelo Auricchio⁹, Giorgio Moschovitis¹⁰, Daniel Hayoz¹¹, Richard Kobza¹², Dipen Shah¹³, Frank Peter Stephan¹⁴, Jürg Schläpfer¹⁵, Marcello Di Valentino¹⁶, Stefanie Aeschbacher^{1

2}, Georg Ehret¹³, Ceylan Eken^{1

2}, Andreas Monsch¹⁷, Laurent Roten¹⁸, Matthias Schwenkglenks^{19

20}, Anne Springer^{1

2}, Christian Sticherling^{1

2}, Tobias Reichlin¹⁸, Christine S Zuern^{1

2}, Pascal B Meyre^{1

2}, Steffen Blum^{1

2}, Tim Sinnecker^{21

22}, Jens Würfel²², Leo H Bonati²¹, David Conen²³, Stefan Osswald^{1

2}; Swiss-AF Investigators

Affiliations

¹ Cardiology/Electrophysiology Division, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
² Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
³ Clinical Trial Unit Basel, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
⁴ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁵ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁶ Department of Cardiology, Triemli Hospital Zürich, Zürich, Switzerland.
⁷ Department of Medicine, Conatonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Zürich, Switzerland.
⁸ Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland.
⁹ Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
¹⁰ Division of Cardiology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.
¹¹ Department of Internal Medicine, HRF-Hôpital Cantonal Fribourg, Fribourg, Switzerland.
¹² Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland.
¹³ Division of Cardiology, Department of Medical Specialities, University Hospital Geneva, Geneva, Switzerland.
¹⁴ Department of Cardiology, Bürgerspital Solothurn, Solothurn, Switzerland.
¹⁵ Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
¹⁶ Division of Cardiology, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
¹⁷ Memory Clinic, Universitäre Altersmedizin, Felix Platter Spital Basel, University of Basel, Basel, Switzerland.
¹⁸ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁹ Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zürich, Switzerland.
²⁰ Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.
²¹ Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland.
²² Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, Univesity of Basel, Basel, Switzerland.
²³ Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON, Canada L8L 2X2.

PMID: 35171989
PMCID: PMC9170478
DOI: 10.1093/eurheartj/ehac020

Silent brain infarcts impact on cognitive function in atrial fibrillation

Michael Kühne et al. Eur Heart J. 2022.

. 2022 Jun 6;43(22):2127-2135.

doi: 10.1093/eurheartj/ehac020.

Authors

Affiliations

¹ Cardiology/Electrophysiology Division, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
² Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
³ Clinical Trial Unit Basel, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
⁴ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁵ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁶ Department of Cardiology, Triemli Hospital Zürich, Zürich, Switzerland.
⁷ Department of Medicine, Conatonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Zürich, Switzerland.
⁸ Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland.
⁹ Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
¹⁰ Division of Cardiology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.
¹¹ Department of Internal Medicine, HRF-Hôpital Cantonal Fribourg, Fribourg, Switzerland.
¹² Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland.
¹³ Division of Cardiology, Department of Medical Specialities, University Hospital Geneva, Geneva, Switzerland.
¹⁴ Department of Cardiology, Bürgerspital Solothurn, Solothurn, Switzerland.
¹⁵ Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
¹⁶ Division of Cardiology, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
¹⁷ Memory Clinic, Universitäre Altersmedizin, Felix Platter Spital Basel, University of Basel, Basel, Switzerland.
¹⁸ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁹ Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zürich, Switzerland.
²⁰ Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.
²¹ Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland.
²² Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, Univesity of Basel, Basel, Switzerland.
²³ Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON, Canada L8L 2X2.

PMID: 35171989
PMCID: PMC9170478
DOI: 10.1093/eurheartj/ehac020

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.

Keywords: Atrial fibrillation; Brain infarction; Cognitive function; Magnetic resonance imaging; Oral anticoagulation.

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Figures

**Structured Graphical Abstract**
Brain damage and change in cognitive function in patients with atrial fibrillation.

**Figure 1**
Change in cognitive scores between baseline and second-year follow-up in patients with or without large non-cortical or cortical infarcts or small non-cortical infarcts identiﬁed at second-year follow-up. Boxes contain the 25 through 75% quartiles (spanning the interquartile range), the thick horizontal line is the median and the red crosses show the means. Whiskers indicate the most extreme values lying within the box-edge and 1.5 × the interquartile range. All eventual further values are plotted as individual points. CoCo, Cognitive Construct score; DSST, Digit Symbol Substitution Test; FUP, follow-up; LNCCI, large non-cortical and cortical infarcts; MoCA, Montreal Cognitive Assessment; SFT, Semantic Fluency Test; SNCI, small non-cortical infarcts; TMT, Trail Making Test.

**Figure 2**
Linear regression model for the change (Δscore) in the Cognitive Construct score for patients with 2-year follow-up data (n = 1139). LNCCI, large non-cortical and cortical infarcts; SNCI, small non-cortical infarcts.

See this image and copyright information in PMC

Comment in

Clinical strokes in atrial fibrillation: the tip of the iceberg.
Jared Bunch T, Steinberg BA. Jared Bunch T, et al. Eur Heart J. 2022 Jun 6;43(22):2136-2138. doi: 10.1093/eurheartj/ehab900. Eur Heart J. 2022. PMID: 35182069 No abstract available.

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Silent brain infarcts impact on cognitive function in atrial fibrillation

Affiliations

Silent brain infarcts impact on cognitive function in atrial fibrillation

Authors

Affiliations

Abstract

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Comment in

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Associated data

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