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
No
J Neurol
Article
Científica
4.849
1.541
14/09/2020
000532878700001
2-s2.0-85084991150
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.
Stroke; Silent brain infarction; Atrial fibrillation; MRI