Association of Hypertension Related Cerebral Small Vessel Disease With Echocardiographic Parameters in Ischemic Stroke Patients With Atrial Fibrillation

Objective: Arterial Hypertension (AHT) is the most important risk factor for cerebral small vessel disease (SVD), which may also be present in stroke patients with atrial fibrillation (AF). Presence of SVD has been shown to be associated with an unfavourable outcome. Here we analysed whether SVD may also be related to altered echocardiographic parameters, frequently observed in AF-stroke patients. Design and method: We included consecutive patients with recent AF-associated ischemic stroke (IS) who underwent echocardiography and brain MRI from the prospective Novel Oral Anticoagulants in Ischemic Stroke Patients registry. We explored the association between echocardiographic parameters and MRI markers of concomitant SVD (cerebral microbleeds/CMB, white matter hyperintensities/WMH) using logistic regression. Results: We included 690 patients with AF-associated IS (median age 80, 45.1% female) In patients with left atrial dilatation, confluent to severe WMH were more common compared to patients with no left atrial dilation (42% vs 27%). Left atrial dilatation (HR 1.96 95% CI [1.36 – 2.91]) and concentric hypertrophy (HR 1.68 95% CI [1.08 – 2.62] were associated with a higher hazard for moderate to severe WMH in the unadjusted, but not in the adjusted logistic regression analysis. No association was observed with the presence of CMB. Conclusions: In AF-associated IS patients, prognostically relevant hypertension-related SVD was more frequently observed in subjects with left atrial dilatation, however there was no independent association. Future studies will have to further determine potentially shared underlying mechanisms of cardiac and cerebral microvascular pathology.