Vascular Brain Injury in Patients with Atrial Fibrillation and Heart Failure

Background and Aims Patients with heart failure (HF) and atrial fibrillation (AF) are at higher risk of vascular brain lesions. Whether AF and HF synergistically amplify this risk is unclear. In this study, we explored the association of HF and AF and their interaction with the prevalence of MRI-detected vascular brain lesions. Methods We analysed 2,712 participants from the Swiss-AF study who underwent standardized brain-MRI and categorised them based on their AF diagnosis and history of HF. In the brain-MRI, we assessed large non-cortical and cortical infarcts (LNCCI), small non-cortical infarcts (SNCI) and white matter hyperintensities (WMH). Logistic regression models were used to analyse associations between AF, HF and their interaction with vascular brain lesions, adjusting for pre-selected covariates. Results Mean age was 73 years and 30.8% were female. The prevalence of ischemic brain infarcts and WMH increased across groups defined by AF and HF status (brain infarcts: AF-/HF- 22.8%, AF-/HF+ 30.2%, AF+/HF- 34.6%, AF+/HF+ 44.6%; WMH: AF-/HF- 43.2% AF-/HF+ 49.7%, AF+/HF- 50.4%, AF+/HF+ 65.6%). No significant interaction between AF and HF was observed for any brain lesion subtype. Both AF and HF (OR, 95% CI, p-value) were independently associated with brain infarcts (AF: 1.78, 1.48-2.16, p<0.001; HF: 1.32, 1.06-1.64, p<0.001) and WMH (AF: 1.71, 1.44-2.03, p<0.001; HF: 1.45, 1.17-1.80, p<0.001). Conclusions AF and HF are independently associated with a higher prevalence of ischemic brain lesions, with the greatest burden observed in patients with both conditions. No interaction was found between AF and HF with regards to vascular brain lesions.