Atrial fibrillation and atherosclerosis cause different vascular brain lesions on magnetic resonance imaging

Tina Stegmann^{1

2}, Raed A Joundi¹, Abhilekh Srivastava¹, Tim Sinnecker^{3

4}, Stefanie Aeschbacher^{5

6}, John W Eikelboom¹, Rolf Wachter², Eric E Smith⁷, Nicolas Rodondi^{8

9}, Jacqueline Bosch¹, Manuel R Blum⁹, Stuart J Connolly¹, Juerg H Beer¹⁰, Kevin W Reeh¹, Tobias Reichlin¹¹, Eva M Lonn^{1

12}, Qilong Yi¹, Andreas S Müller¹³, Kelley R H Branch¹⁴, Marcello Di Valentino^{15

16}, Alvaro Avezum¹⁷, Keith A A Fox¹⁸, Peter Ammann¹⁹, Leo H Bonati³, Giorgio Moschovitis²⁰, Philipp Krisai^{5

6}, Michael Kühne^{5

6}, Stefan Osswald^{5

6}, Mukul Sharma¹, David Conen¹

Affiliations

¹ Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton L8L 2X2, ON, Canada.
² Department of Cardiology, Leipzig University Hospital, Liebigstrasse 20, Leipzig 04103, Germany.
³ Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland.
⁴ Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
⁵ Cardiology/Electrophysiology Division, University Heart Center, University Hospital Basel, University of Basel, Basel, Switzerland.
⁶ Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
⁷ Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
⁸ Institute of Primary Health Care (BIHAM), Faculty of Medicine, University of Bern, Bern, Switzerland.
⁹ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁰ Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Zürich, Switzerland.
¹¹ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹² Department of Medicine, McMaster University, Hamilton, Canada.
¹³ Department of Cardiology, Triemli Hospital Zürich, Zürich, Switzerland.
¹⁴ Heart Institute, Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA.
¹⁵ Department of Cardiology, Clinica Luganese Moncucco, Lugano, Switzerland.
¹⁶ Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland.
¹⁷ Research Division, Dante Pazzanese Institute of Cardiology, São Paulo University, São Paulo, Brazil.
¹⁸ Department of Cardiology, University of Edinburgh, Edinburgh, UK.
¹⁹ Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland.
²⁰ Division of Cardiology, Cardiocentro Ticino Institute, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.

PMID: 40878829
DOI: 10.1093/eurheartj/ehaf550

Atrial fibrillation and atherosclerosis cause different vascular brain lesions on magnetic resonance imaging

Tina Stegmann et al. Eur Heart J. 2025.

. 2025 Aug 29:ehaf550.

doi: 10.1093/eurheartj/ehaf550. Online ahead of print.

Authors

Affiliations

¹ Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton L8L 2X2, ON, Canada.
² Department of Cardiology, Leipzig University Hospital, Liebigstrasse 20, Leipzig 04103, Germany.
³ Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland.
⁴ Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
⁵ Cardiology/Electrophysiology Division, University Heart Center, University Hospital Basel, University of Basel, Basel, Switzerland.
⁶ Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
⁷ Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
⁸ Institute of Primary Health Care (BIHAM), Faculty of Medicine, University of Bern, Bern, Switzerland.
⁹ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁰ Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Zürich, Switzerland.
¹¹ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹² Department of Medicine, McMaster University, Hamilton, Canada.
¹³ Department of Cardiology, Triemli Hospital Zürich, Zürich, Switzerland.
¹⁴ Heart Institute, Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA.
¹⁵ Department of Cardiology, Clinica Luganese Moncucco, Lugano, Switzerland.
¹⁶ Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland.
¹⁷ Research Division, Dante Pazzanese Institute of Cardiology, São Paulo University, São Paulo, Brazil.
¹⁸ Department of Cardiology, University of Edinburgh, Edinburgh, UK.
¹⁹ Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland.
²⁰ Division of Cardiology, Cardiocentro Ticino Institute, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.

PMID: 40878829
DOI: 10.1093/eurheartj/ehaf550

Abstract

Background and aims: Atrial fibrillation (AF) and atherosclerosis pre-dispose to the occurrence of vascular brain lesions compared with the general population, yet direct comparisons of brain lesion patterns between these two cardiovascular patient groups are lacking. This study sought to compare the prevalence and distribution of vascular brain lesions on cerebral magnetic resonance imaging (MRI) between patients with AF and those with atherosclerosis.

Methods: Baseline clinical data and standardized brain MRI scans from the Swiss Atrial Fibrillation cohort study (Swiss-AF; representing patients with AF) and the COMPASS MRI sub-study (COMPASS MIND; representing patients with atherosclerosis without AF) were used to compare the prevalence of lacunar and non-lacunar infarcts, periventricular and deep white matter hyperintensities (WMH), and cerebral micro-bleeds (CMB) between groups.

Results: Overall, 3508 patients were included (AF: n = 1748; atherosclerosis: n = 1760). Mean age was 73 (±8) years in the AF cohort and 71 (±6) years in the atherosclerosis cohort, 28% and 23% were female, 90% of the AF patients took oral anti-coagulation, 93% of the atherosclerosis patients took anti-platelet therapy. AF patients were more likely to have non-lacunar infarcts (22% vs 10%; P < .001), and atherosclerosis patients were more likely to have lacunar infarcts (21% vs 26%; P = .001). A higher grade of periventricular WMH was seen in AF patients (49% vs 37%; P < .001). The presence of CMB were more common in atherosclerosis patients (22% vs 29%; P < .001). In multi-variable analyses, AF patients had a higher odds ratio (OR) of non-lacunar infarcts (OR 2.28, 95% confidence interval [CI] 1.86-2.81; P < .001), lower odds of lacunar infarcts (OR 0.66, 95% CI 0.56-0.79; P < .001), and higher odds of severe periventricular WMH (OR 1.42, 95% CI 1.22-1.67; P < .001) compared with atherosclerosis patients.

Conclusions: Patients with AF had a higher rate of non-lacunar infarcts, multi-infarct patterns and more severe periventricular white matter disease compared with patients with atherosclerosis. These findings support disease-specific mechanisms in the development of vascular brain lesions in patients with cardiovascular disease.

Keywords: Atherosclerosis; Atrial fibrillation; Brain MRI; Cerebral infarcts; Cerebral micro-bleeds; White matter hyperintensities.

© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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Atrial fibrillation and atherosclerosis cause different vascular brain lesions on magnetic resonance imaging

Affiliations

Atrial fibrillation and atherosclerosis cause different vascular brain lesions on magnetic resonance imaging

Authors

Affiliations

Abstract

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