Atrial fibrillation (AF) is associated with cognitive decline, even in the absence of clinical stroke. The Swiss AF Cohort (SWISS-AF) study sought to quantify the incidence of silent brain infarcts in patients with AF. Investigators then explored the relationship between silent brain infarcts and cognitive decline. Finally, they also examined if anticoagulation seemed to have any role to prevent or reduce the risk of cognitive decline.
SWISS-AF (NCT02105844) is an ongoing prospective, observational cohort study being conducted at 14 centres across Switzerland. Investigators enrolled 1227 patients with AF to undergo brain magnetic resonance imaging (MRI) and cognitive function at baseline and again at a 2-year follow-up. All new lesions that had formed during the follow-up period were quantified as small or large cortical lesions, white matter lesions (WML) or microbleeds (Mb).
At 2-year follow-up, 28 (2.3%) patients had experienced either a clinical stroke or a transient ischemic attack (TIA), and 68 (5.5%) had developed ≥ 1 new infarct. New infarcts were clinically silent in 58 (85.3%) of patients. Patients with brain infarcts showed a more dramatic decline in cognitive function than those without new brain infarcts.
The authors noted the age per 10-year increase and a history of prior stroke/TIA were associated with a higher risk of developing a new brain infarct. New WML had developed in 229 (18.7%) patients, and Mb had occurred in 136 (11.4%) patients. Meanwhile, patients with new WML or Mb did not demonstrate cognitive decline.
At baseline, 1103 (89.9%) patients were on anticoagulant therapy; at the 2-year follow-up, this number had decreased slightly, to 1037 (84.7%). Nearly 90% of all new brain infarcts occurred in anticoagulated patients.
Kühne et al. concluded that clinically overt and silent brain infarcts have comparable implications for cognitive decline. Anticoagulation alone may not constitute adequate protection against brain damage and cognitive impairment in patients with AF.
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Author: Kelly Schoonderwoerd
Original article: Kühne et. al. Eur Hear J. 2022 February 17: 1-9