When Should Heparin Be Given to Patients With Atrial Fibrillation–Related Embolic Brain Infarcts?

The omega-3 fatty acid (n-3 FA) eicosapentaenoic acid (EPA) reduces stroke in patients with atherosclerotic cardiovascular disease. Whether EPA affects stroke or cerebral small vessel dis-ease in patients with atrial fibrillation (AF) remains uncertain. EPA, docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), and alpha-linolenic acid (ALA) were determined by gas chromatography in 1657 AF patients from the Swiss Atrial Fibrillation study. All patients underwent brain MRI to detect ischemic brain infarcts, classified as large noncortical or cortical infarcts (LNCCIs); markers of small vessel disease, classified as small noncortical infarcts (SNCIs), number of microbleeds, and white matter lesion (WML) volumes. Individual and total n-3 FAs (EPA + DHA + DPA + ALA) were correlated with LNCCIs and SNCIs using logistic regression, with numbers of microbleeds using a hurdle model, and WML volumes using linear regression. LNCCIs were detected in 372 patients (22.5%). EPA correlated inversely with the prevalence of LNCCIs (odds ratio [OR] 0.51 per increase of 1 percentage point EPA, 95% confidence interval [CI] 0.29–0.90). DPA correlated with a higher LNCCI prevalence (OR 2.48, 95%CI 1.49–4.13). No associations with LNCCIs were found for DHA, ALA, and total n-3 FAs. Neither individual nor total n-3 FAs correlated with markers of small vessel disease. In conclusion, EPA correlates inversely with the prevalence of ischemic brain infarcts, but not with markers of small vessel disease in patients with AF.

Download Full-text

P3712The omega-3 fatty acid eicosapentaenoic acid (EPA) is inversely associated with ischemic brain infarcts in elderly patients with atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz745.0566 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M F Reiner ◽

P Baumgartner ◽

A Wiencierz ◽

S Aeschbacher ◽

N Rodondi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Elderly Patients ◽

Eicosapentaenoic Acid ◽

Brain Mri ◽

Omega 3 ◽

Total N ◽

Stroke Incidence ◽

Ischemic Brain ◽

Brain Infarcts

Abstract Background The association of individual omega-3 fatty acids (n-3 FAs) with ischemic stroke remains unclear. Experimental data strongly suggest that n-3 FAs reduce ischemic stroke due to their anti-thrombotic and anti-inflammatory properties. Yet, recent clinical trials yielded mixed results. While marine n-3 FA supplementation (1g/day) did not reduce stroke, icosapent ethyl, a purified eicosapentaenoic acid (EPA) ethyl ester (4g/day), significantly reduced stroke incidence in patients at high cardiovascular risk. In the current study, we examined the association of fish-derived EPA, docosapentaenoic acid (DPA), docosahexaenoic acid (DHA) and the plant-derived alpha-linolenic acid (ALA) with the prevalence of ischemic brain infarcts in elderly patients with atrial fibrillation. Methods In this cross-sectional analysis of the Swiss atrial fibrillation (swissAF) cohort study, we determined baseline whole blood n-3 FAs by gas chromatography according to the HS-Omega-3 Index methodology in 1665 patients aged ≥65 years with atrial fibrillation. Large non-cortical and cortical infarcts (LNCCI) were assessed by brain MRI. Total and individual n-3 FAs were correlated with the prevalence of LNCCI in a logit model with continuous factors. Analyses were adjusted for sex, age, body mass index, smoking, alcohol intake, family history of cardiovascular disease and atrial fibrillation, physical activity, hypertension, diabetes, chronic kidney disease, prior stroke, prior transient ischemic attack, aspirin, anticoagulation and type of atrial fibrillation. Results A total of 373 patients with LNCCI (22.4%) were identified. After adjustment, lower risk of LNCCI was associated with higher EPA (odds ratio [OR] 0.50 per increase of one percentage point EPA, 95% confidence interval [CI] 0.28–0.88) and a higher risk was detected with DPA (OR 2.39, 95% CI 1.43–4.01). No statistically significant association was detected with DHA (OR 1.13, 95% CI 0.94–1.35), ALA (OR 0.83, 95% CI 0.23–2.95) or total n-3 FAs (OR 1.03, 95% CI 0.92–1.16). Conclusions Higher levels of EPA are associated with a lower prevalence of ischemic infarcts in aged patients with atrial fibrillation. Unexpectedly, DPA shows a direct correlation with ischemic infarcts. This study demonstrates that individual n-3 FAs may differentially affect stroke risk and that supplementation of EPA may be an interesting strategy to prevent ischemic stroke in atrial fibrillation patients. Acknowledgement/Funding Swiss National Science Foundation

Download Full-text

Association of platelet-to-lymphocyte ratio with silent brain infarcts in patients with paroxysmal atrial fibrillation

Neurological Research ◽

10.1080/01616412.2016.1210357 ◽

2016 ◽

Vol 38 (9) ◽

pp. 753-758 ◽

Cited By ~ 7

Author(s):

Ozge Altintas ◽

Abdurrahman Tasal ◽

Elvin Niftaliyev ◽

Okkes Taha Kucukdagli ◽

Talip Asil

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Brain Infarcts

Download Full-text

Association of Heart Rate Variability With Silent Brain Infarcts in Patients With Atrial Fibrillation

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.684461 ◽

2021 ◽

Vol 8 ◽

Author(s):

Peter Hämmerle ◽

Christian Eick ◽

Sven Poli ◽

Steffen Blum ◽

Vincent Schlageter ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Autonomic Dysfunction ◽

Brain Mri ◽

Low Frequency ◽

Total Power ◽

Brain Infarcts ◽

Clinical Covariates ◽

Prior Stroke ◽

Mean Heart Rate

Purpose: Silent brain infarcts (SBI) are frequently detected in patients with atrial fibrillation (AF), but it is unknown whether SBI are linked to autonomic dysfunction. We aimed to explore the association of autonomic dysfunction with SBI in AF patients.Methods: 1,358 AF patients without prior stroke or TIA underwent brain MRI and 5-min resting ECG. We divided our cohort into AF patients who presented in sinus rhythm (SR-group, n = 816) or AF (AF-group, n = 542). HRV triangular index (HRVI), standard deviation of normal-to-normal intervals, mean heart rate, root mean square root of successive differences of normal-to-normal intervals, 5-min total power and power in the low frequency, high frequency and very low frequency range were calculated. Primary outcome was presence of SBI in the SR group, defined as large non-cortical or cortical infarcts. Secondary outcomes were SBI volumes and topography.Results: Mean age was 72 ± 9 years, 27% were female. SBI were detected in 10.5% of the SR group and in 19.9% of the AF group (p < 0.001). HRVI <15 was the only HRV parameter associated with the presence of SBI after adjustment for clinical covariates in the SR group [odds ratio (OR) 1.67; 95% confidence interval (CI): 1.03–2.70; p = 0.037]. HRVI <15 was associated with larger brain infarct volumes [β (95% CI) −0.47 (−0.84; −0.09), p = 0.016] in the SR group and was more frequently observed in patients with right- than left-hemispheric SBI (p = 0.017).Conclusion: Impaired HRVI is associated with SBI in AF patients. AF patients with autonomic dysfunction might undergo systematic brain MRI screening to initiate intensified medical treatment.Clinical Trials Gov Identifier: NCT02105844.

Download Full-text

Biomarkers, Clinical Variables, and the CHA2DS2-VASc Score to Detect Silent Brain Infarcts in Atrial Fibrillation Patients

Journal of Stroke ◽

10.5853/jos.2021.02068 ◽

2021 ◽

Vol 23 (3) ◽

pp. 449-452

Author(s):

Philipp Krisai ◽

Ceylan Eken ◽

Stefanie Aeschbacher ◽

Michael Coslovsky ◽

Vinzent Rolny ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Variables ◽

Brain Infarcts

Download Full-text

Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease: A Population-Based MRI Study

Neurology ◽

10.1212/wnl.0000000000012675 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012675

Author(s):

Lina Rydén ◽

Simona Sacuiu ◽

Hanna Wetterberg ◽

Jenna Najar ◽

Xinxin Guo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Small Vessel Disease ◽

Brain Mri ◽

Population Based ◽

Cerebrovascular Diseases ◽

Register Data ◽

Self Report ◽

Birth Date ◽

Intracranial Volume ◽

Brain Infarcts

Background and Objectives:Atrial fibrillation (AF) has been associated with cognitive decline and dementia. However, the mechanisms behind these associations are not clear. Examination of cerebrovascular pathology on MRI may shed light on how AF affects the brain. This study aimed to determine whether AF is associated with a broad range of cerebrovascular diseases, beyond the well-known association with symptomatic stroke, including silent infarcts and markers of small vessel disease, e.g. cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and lacunes, in a population-based sample of 70-year-olds.Methods:Data were obtained from the Gothenburg H70 Birth Cohort Studies, where individuals are invited based on birth-date. This study has a cross-sectional design and includes individuals born 1944 who underwent structural brain MRI in 2014-17. AF diagnoses were based on self-report, EKG, and register data. Symptomatic stroke was based on self-report, proxy-interviews, and register data. Brain infarcts and CMBs were assessed by a radiologist. WMH volumes were measured on FLAIR images using the Lesion Segmentation Tool. Multivariate logistic regression was used to study the association between AF and infarcts/CMBs, and multivariate linear regression was used to study the association between AF and WMHs.Results:A total of 776 individuals were included and 65 (8.4%) had AF. AF was associated with symptomatic stroke (OR 4.5, 95% CI 2.1-9.5), and MRI findings of large infarcts (OR 5.0, 95% CI 1.5-15.9), lacunes (OR 2.7, 95% CI 1.2-5.6), and silent brain infarcts (OR 3.5; 95% CI 1.6-7.4). Among those with symptomatic stroke, individuals with AF had larger WMH volumes (0.0137 ml/total intracranial volume (TIV), 95% CI 0.0074-0.0252) compared to those without AF (0.0043 ml/TIV, 95% CI 0.0029-0.0064). There was no association between AF and WMH volumes among those without symptomatic stroke. In addition, AF was associated to CMBs in the frontal lobe.Discussion:AF was associated with broad range of cerebrovascular pathologies. Further research is needed to establish whether cerebrovascular MRI markers can be added to current treatment guidelines to further personalise anticoagulant treatment in AF patients and to further characterize the pathogenetic processes underlying the associations between AF and cerebrovascular diseases, as well as dementia.

Download Full-text