Silent cerebral ischemia in patients with chronic atrial fibrillation — A case-control study

Abstract

The cerebral CT-scan results of 72 patients with chronic atrial fibrillation (AF) were compared to those of an age- and sex-matched control group, affected by muscle-tensive headache. None of the patients in the study had any neurologic symptoms. All were normal on neurologic examination. Mean age was 68 years in both groups. Patients with atrial fibrillation had a higher prevalence of hypertension, diabetes and hyperlipidemia, although the differences were not significant. Thirty-two patients (44.4%) with AF showed hypodense lesions on cerebral CT-scan, suggestive of small infarcts, whereas this finding was present only in eight control subjects (11.1%) (p less than 0.05). These results confirm in part the observations reported in literature and suggest a more thorough examination of the problem regarding the prophylaxis of thrombo-embolic risk in patients affected by chronic AF.

Association Between Atrial Fibrillation and Silent Cerebral Infarctions

“…The association between SCIs and paroxysmal AF and persistent AF was adequately described in 2 (12, 19) and 3 studies (18, 32, 34), respectively (Table 2). The association between AF and SCIs was statistically significant, regardless of the AF type.…”

“…Control patients were age- and sex-matched in SR, considered themselves healthy, and previously participated in the Copenhagen City Heart Study. History of cerebrovascular disease, abnormal neurologic examination, anticoagulants or aspirin therapy, history of alcohol abuse, and bad-quality CT; patients with cardiovascular events were excluded from the control group Chronic AF of >1 y duration diagnosed by ECG No All CT results were evaluated blindly by 2 consultant neuroradiologists* Feinberg et al, 1990 (17) CT Nonprospective study reporting the prevalence of SCIs in a large group of patients with NVAF participating in SPAF study Patients with NVAF aged >21 y participating in the SPAF study from 15 centers in the United States Cardiac exclusions: self-limited AF, mitral stenosis, NYHA-IV CHF, idiopathic cardiomyopathy in conjunction with CHF, prosthetic heart valve, MI, percutaneous transluminal angioplasty within 1 y, unstable angina, and CABG within 3 mo. Noncardiac exclusions: dementia, renal failure, any illness reducing life expectancy to <24 mo, any condition requiring antiplatelet or anticoagulant, and history of a stroke or TIA. NVAF diagnosed by ECG † No 2 independent authors blinded to the clinical data read CT results using a standardized assessment form (disagreement in SCI diagnosis was seen in 8% of CT scans, and disagreement in SCI location was seen in 3%) Guidotti et al, 1990 (18) CT Nonprospective study with calculable prevalence and risk estimate (comparing patients with AF with age- and sex-matched control patients without AF) Case patients had ≥1 y ECG documented AF, without historical or instrumental evidence of rheumatic heart disease. Control patients were in SR without cardiopathy affected by muscle-tensive headache, diagnosed according to strict criteria. Previous MI or thyroid disease, severe enlarged hearts, CHF, history of cerebrovascular events, abnormal neurologic examination, and antiaggregant or anticoagulant therapy NRAF diagnosed by ECG No CT results were examined by a neuroradiologist who was blinded to the patients’ condition Ezekowitz et al, 1995 (33) CT Prospective study of many patients with NRAF reporting prevalence and incidence of SCIs during 3 y of follow-up Men of any age with AF documented by 2 ECGs ≥4 wk apart and no echocardiographic evidence of rheumatic heart disease; baseline prothrombin times had to be within the ...…”

Implications of silent strokes

“…Subclinical infarcts have been found in a variety of clinical contexts, including patients with extracranial occlusive disease with asymptomatic carotid stenosis [10], atrial fibrillation [3,[22][23][24][25][26][27][28][29][30][31], symptomatic cerebrovascular disease [25][26][27]32], and prothrombotic conditions such as sickle cell anemia.…”

Silent Cerebral İnfarction in Anticoagulated Patients with Non-valvular Atrial Fibrillation as Detected with Neuron Specific Enolase

“…AF olan hastalarda inme riski 3-5 kat artmaktadır. İnme, geçici iskemik atak (GİA) gibi herhangi bir klinik olmaksızın serebral hasarın olması sessiz serebral infarkt (SSİ) olarak tanımlanır ve uzun dönemde nörolojik defisit (2,3), kognitif bozukluk (4,5), psikiyatrik bozukluk (depresyon gibi) (3,6) ve klinik olarak ortaya çıkan inme (7,8) ve hatta artmış mortalite (7,9) ile ilişkilidir. AF'li hastalarda SSİ prevalansını değerlendiren çalışmalarda ise heterojen sonuçlar rapor edilmiştir.…”