Key result
Stroke-free permanent AF links to mild cognitive impairment in 40% of patients, associated with higher LAVI.
Why the study?
Cognitive impairment frequently occurs in AF without overt stroke, implicating non-embolic mechanisms, leading investigators to evaluate whether atrial remodeling and impaired cerebral hemodynamics associate with mild cognitive impairment in permanent AF.
Cross-Sectional (n=252)
In stroke-free patients with permanent atrial fibrillation, mild cognitive impairment is highly prevalent and independently associated with left atrial remodeling and impaired diastolic cerebral perfusion.
Highlights a 40% prevalence of cognitive impairment despite anticoagulation; leaves open whether targeting left.
Background/Objectives: Cognitive impairment is highly prevalent in atrial fibrillation (AF) and frequently occurs in the absence of overt stroke, implicating non-embolic mechanisms. We hypothesized that atrial remodeling and impaired cerebral hemodynamics are associated with mild cognitive impairment (MCI) in permanent AF. Methods: In this cross-sectional study, 252 stroke-free patients with permanent AF receiving direct oral anticoagulants (DOACs) underwent transthoracic echocardiography and transcranial Doppler (TCD) assessment of middle cerebral artery flow. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were analyzed. Multivariable logistic regression identified factors independently associated with MCI, and receiver operating characteristic (ROC) curves evaluated discriminative performance. Results: MCI was present in 40% of patients (101/252). AF-MCI patients were older and showed greater left atrial remodeling, reflected by increased left atrial diameter and left atrial volume index (LAVI) (both p ≤ 0.001), without differences in left ventricular systolic function. TCD demonstrated reduced EDV and increased RI in the MCI group (all p ≤ 0.01), whereas PSV showed minimal differences. In multivariable analysis, age, LAVI, and average RI were independently associated with MCI. Age showed excellent discrimination (AUC 0.858), whereas maximum RI demonstrated moderate discrimination (AUC 0.645; p < 0.001 for comparison). Conclusions: In stroke-censored permanent atrial fibrillation, cognitive impairment was associated with atrial remodeling and impaired diastolic cerebral perfusion, consistent with a potential contribution of chronic hypoperfusion and increased microvascular resistance. Combined echocardiographic and cerebral hemodynamic assessment may help characterize hemodynamic patterns associated with cognitive impairment in AF.
No takes yet. Share an insight, caveat, or question.
Arnăutu et al. (2026) conducted a cross-sectional in Permanent atrial fibrillation (n=252). Mild cognitive impairment (MCI) vs. No MCI was evaluated on Mild cognitive impairment (MCI). Mild cognitive impairment affected 40% of stroke-free patients with permanent atrial fibrillation and was independently associated with age, left atrial volume index, and average resistive index.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: