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. 2022 Sep;9(2):e002033.
doi: 10.1136/openhrt-2022-002033.

Sex differences of vascular brain lesions in patients with atrial fibrillation

Selinda Ceylan  1   2 , Stefanie Aeschbacher  1   2 , Anna Altermatt  3 , Tim Sinnecker  3 , Nicolas Rodondi  4   5 , Manuel Blum  4   5 , Michael Coslovsky  1   6 , Simone Evers-Dörpfeld  1   2 , Sacha Niederberger  1   2 , David Conen  7 , Stefan Osswald  1   2 , Michael Kühne  1   2 , Marco Düring  3 , Jens Wuerfel  3 , Leo Bonati  8   9 ; SWISS-AF Investigators
Collaborators, Affiliations

Sex differences of vascular brain lesions in patients with atrial fibrillation

Selinda Ceylan et al. Open Heart. 2022 Sep.

Abstract

Objective: To examine sex differences in prevalence, volume and distribution of vascular brain lesions on MRI among patients with atrial fibrillation (AF).

Methods: In this cross-sectional analysis, we included 1743 patients with AF (27% women) from the multicentre Swiss Atrial Fibrillation study (SWISS-AF) with available baseline brain MRI. We compared presence and total volume of large non-cortical or cortical infarcts (LNCCIs), small non-cortical infarcts, microbleeds (MB) and white matter hyperintensities (WMH, Fazekas score ≥2 for moderate or severe degree) between men and women with multivariable logistic regression. We generated voxel-based probability maps to assess the anatomical distribution of lesions.

Results: We found no strong evidence for an association of female sex with the prevalence of all ischaemic infarcts (LNCCI and SNCI combined; adjusted OR 0.86, 95% CI 0.67 to 1.09, p=0.22), MB (adjusted OR 0.91, 95% CI 0.68 to 1.21, p=0.52) and moderate or severe WMH (adjusted OR 1.15, 95% CI 0.90 to 1.48, p=0.27). However, total WMH volume was 17% larger among women than men (multivariable adjusted multiplicative effect 1.17, 95% CI 1.01 to 1.35; p=0.04). Lesion probability maps showed a right hemispheric preponderance of ischaemic infarcts in both men and women, while WMH were distributed symmetrically.

Conclusion: Women had higher white matter disease burden than men, while volume and prevalence of other lesions did not differ. Our findings highlight the importance of controlling risk factors for cerebral small vessel disease in patients with AF, especially among women.

Keywords: Atrial Fibrillation; Atrial Flutter; STROKE.

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Conflict of interest statement

Competing interests: AA reports no disclosures; DC received speaker fees from Servier, Canada, outside of the current work; JW is an employee of MIAC AG, has received funding from EU (Horizon2020), Else-Kröner-Fresenius Foundation, Novartis Foundation, and consultancy, steering committee, advisory board and speaker honoraria from Actelion, Bayer, Biogen, Idorsia, Roche, Sanofi-Genzyme and Teva; LHB received grants from the Swiss National Science Foundation (PBBSB-116873, 33CM30-124119, 32003B-156658; Berne, Switzerland), The Swiss Heart Foundation (Berne, Switzerland, and the University of Basel (Basel, Switzerland). LHB has received an unrestricted research grant from AstraZeneca, and consultancy or advisory board fees or speaker’s honoraria from Amgen, Bayer, Bristol-Myers Squibb, and Claret Medical, and travel grants from AstraZeneca and Bayer; MC reports no disclosures; MD received honoraria for lectures from Pfizer, Bayer and Sonofi Genzyme, is a consultant for Hovid Berhad and Roche Pharma; MK reports personal fees from Bayer, personal fees from Böhringer Ingelheim, personal fees from Pfizer BMS, personal fees from Daiichi Sankyo, personal fees from Medtronic, personal fees from Biotronik, personal fees from Boston Scientific, personal fees from Johnson&Johnson, grants from Bayer, grants from Pfizer, grants from Boston Scientific, grants from BMS, grants from Biotronik; MRB reports no disclosures; NR received a grant from the Swiss Heart Foundation; SA reports no disclosures; SC reports no disclosures; SE-D reports no disclosures; SN reports no disclosures; SO reports no disclosures; TS reports no disclosures.

Figures

Figure 1
Figure 1
Violin plot of the log-transformed volume of ischaemic infarcts (LNCCI and SNCI combined) and WMH stratified by sex. The figure shows the distribution of ischaemic infarct volume (LNCCI and SNCI combined) and WMH volume in the SWISS-AF patients with successful co-registration (n=1716) compared between men and women. LNCCI, large non-cortical or cortical infarct; SNCI, small non-cortical infarct; SWISS-AF, Swiss Atrial Fibrillation study; WMH, white matter hyperintensity.
Figure 2
Figure 2
Localisation of ischaemic lesions (LNCCI and SNCI combined) stratified by sex. The figure shows the distribution of ischaemic lesions (LNCCI and SNCI, except acute lesions) in the SWISS-AF patients with successful co-registration (n=1716) compared between men and women in a standard space. The colour indicates that a voxel is affected by an ischaemic lesion in this percentage (%) of patients. LNCCI, large non-cortical or cortical infarct; SNCI, small non-cortical infarct; SWISS-AF, Swiss Atrial Fibrillation study.
See this image and copyright information in PMC

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