Title Prevalence and risk factors of silent brain infarcts in patients with AF detected by 3T-MRI
Authors Escudero-Martinez, Irene, Ocete, Rafael F., Mancha, Fernando, Vega, Angela, Pinero, Pilar, Lopez-Rueda, Antonio, Fajardo, Elena, Algaba, Pilar, Fernandez-Engo, Jose Roman, Martin-Sanchez, Eva M., GALVAO CARMONA, ALEJANDRO, Zapata-Arriaza, Elena, Lebrato, Lucia, Pardo-Galiana, Blanca, Cabezas, Juan Antonio, Ayuso, Maria Irene, Gonzalez, Alejandro, Moniche, Francisco, Montaner, Joan, GALVAO CARMONA, ALEJANDRO
External publication No
Means J. Neurol.
Scope Article
Nature Científica
JCR Quartile 1
SJR Quartile 1
Area International
Publication date 01/01/2020
ISI 000532878700001
DOI 10.1007/s00415-020-09887-0
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 CHADS(2) and CHA(2)DS(2)VASc score. Methods Patients with a history of AF based on medical records who scored 0-1 in the CHADS(2) 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 CHA(2)DS(2)VASc 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 CHADS(2) and in the low-risk population according to CHA(2)DS(2)VASc. Although further studies are needed, a neuroimaging screening might be justified in these patients to guide medical therapies to improve stroke prevention.
Keywords Stroke; Silent brain infarction; Atrial fibrillation; MRI
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