Key result
Silent brain infarcts in anticoagulated AF patients are linked to measurable cognitive decline.
Why the study?
The association between clinically overt and silent brain lesions and cognitive function in atrial fibrillation patients remained to be investigated.
Cohort (n=1,227)
Yes
Mean Difference: -0.14 (95% CI -0.21–-0.06)
p-value: p=<0.0001
In patients with atrial fibrillation, incident clinically silent brain infarcts are common despite high rates of anticoagulation and are associated with cognitive decline similar to that seen with overt strokes.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“When it comes to our understanding of the link between clinical stroke and AF, what we have known so far is only the tip of the iceberg. This clinical study set out to understand why AF patients suffer from higher rates of cognitive decline even without experiencing a stroke, and provide the clinical field a better understanding of the impact silent brain lesions have on cognitive decline.”
“Anticoagulation in AFib patients is critical, but it also is not enough. It calls for a more comprehensive approach to prevention, with attention to atherosclerotic cardiovascular disease risk factors in AFib patients, including interventions that address hypertension, diabetes, hyperlipidemia, and smoking cessation.”
“I believe this is robust and new evidence that AF is not only a marker of comorbidity... but that the arrhythmia—AF—per se matters and is associated with more brain infarcts and more cognitive decline compared to patients without atrial fibrillation. This suggests that we should take AF seriously and that we should take care of AF, probably by means beyond oral anticoagulation.”
Silent infarcts associate with cognitive decline in anticoagulated AF; leaves open whether intensified prevention alters trajectories.
AIMS: We aimed to investigate the association of clinically overt and silent brain lesions with cognitive function in atrial fibrillation (AF) patients. METHODS AND RESULTS: We enrolled 1227 AF patients in a prospective, multicentre cohort study (Swiss-AF). Patients underwent standardized brain magnetic resonance imaging (MRI) at baseline and after 2 years. We quantified new small non-cortical infarcts (SNCIs) and large non-cortical or cortical infarcts (LNCCIs), white matter lesions (WML), and microbleeds (Mb). Clinically, silent infarcts were defined as new SNCI/LNCCI on follow-up MRI in patients without a clinical stroke or transient ischaemic attack (TIA) during follow-up. Cognition was assessed using validated tests. The mean age was 71 years, 26.1% were females, and 89.9% were anticoagulated. Twenty-eight patients (2.3%) experienced a stroke/TIA during 2 years of follow-up. Of the 68 (5.5%) patients with ≥1 SNCI/LNCCI, 60 (88.2%) were anticoagulated at baseline and 58 (85.3%) had a silent infarct. Patients with brain infarcts had a larger decline in cognition [median (interquartile range)] changes in Cognitive Construct score [-0.12 (-0.22; -0.07)] than patients without new brain infarcts [0.07 (-0.09; 0.25)]. New WML or Mb were not associated with cognitive decline. CONCLUSION: In a contemporary cohort of AF patients, 5.5% had a new brain infarct on MRI after 2 years. The majority of these infarcts was clinically silent and occurred in anticoagulated patients. Clinically, overt and silent brain infarcts had a similar impact on cognitive decline. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02105844, https://clinicaltrials.gov/ct2/show/NCT02105844.
No takes yet. Share an insight, caveat, or question.
Kühne et al. (2022) conducted a cohort in Atrial fibrillation (n=1,227). New clinically silent brain infarcts vs. No new brain infarcts was evaluated on Change in Cognitive Construct (CoCo) score (MD -0.14, 95% CI -0.21 to -0.06, p=<0.0001). New clinically silent brain infarcts occurred in atrial fibrillation patients despite anticoagulation and were associated with a significant decline in cognitive function (MD -0.14).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: