Herm Juliane, Schurig Johannes, Martinek Martin R, Höltgen Reinhard, Schirdewan Alexander, Kirchhof Paulus, Wieczorek Marcus, Pürerfellner Helmut, Heuschmann Peter U, Fiebach Jochen B, Haeusler Karl Georg
Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria.
BMC Cardiovasc Disord. 2019 Mar 12;19(1):58. doi: 10.1186/s12872-019-1035-1.
Atrial fibrillation (AF) without other stroke risk factors is assumed to have a low annual stroke risk comparable to patients without AF. Therefore, current clinical guidelines do not recommend oral anticoagulation for stroke prevention of AF in patients without stroke risk factors. We analyzed brain magnetic resonance imaging (MRI) imaging to estimate the rate of clinically inapparent ("silent") ischemic brain lesions in these patients.
We pooled individual patient-level data from three prospective studies comprising stroke-free patients with symptomatic AF. All study patients underwent brain MRI within 24-48 h before planned left atrial catheter ablation. MRIs were analyzed by a neuroradiologist blinded to clinical data.
In total, 175 patients (median age 60 (IQR 54-67) years, 32% female, median CHADS-VASc = 1 (IQR 0-2), 33% persistent AF) were included. In AF patients without or with at least one stroke risk factor, at least one silent ischemic brain lesion was observed in 4 (8%) out of 48 and 10 (8%) out of 127 patients, respectively (p > 0.99). Presence of silent ischemic brain lesions was related to age (p = 0.03) but not to AF pattern (p = 0.77). At least one cerebral microbleed was detected in 5 (13%) out of 30 AF patients without stroke risk factors and 25 (25%) out of 108 AF patients with stroke risk factors (p = 0.2). Presence of cerebral microbleeds was related to male sex (p = 0.04) or peripheral artery occlusive disease (p = 0.03).
In patients with symptomatic AF scheduled for ablation, brain MRI detected silent ischemic brain lesions in approximately one in 12 patients, and microbleeds in one in 5 patients. The prevalence of silent ischemic brain lesions did not differ in AF patients with or without further stroke risk factors.
无其他卒中危险因素的心房颤动（AF）患者被认为年卒中风险较低，与无AF的患者相当。因此，当前临床指南不建议对无卒中危险因素的AF患者进行口服抗凝治疗以预防卒中。我们分析了脑部磁共振成像（MRI），以评估这些患者中临床隐匿性（“无症状性”）缺血性脑损伤的发生率。
我们汇总了三项前瞻性研究中个体患者水平的数据，这些研究纳入了无卒中的有症状AF患者。所有研究患者在计划进行左心房导管消融术前24 - 48小时内接受脑部MRI检查。MRI由一位对临床数据不知情的神经放射科医生进行分析。
共纳入175例患者（中位年龄60（四分位间距54 - 67）岁，女性占32%，CHADS - VASc中位数 = 1（四分位间距0 - 2），持续性AF占33%）。在无或有至少一项卒中危险因素的AF患者中，48例患者中有4例（8%）、127例患者中有10例（8%）观察到至少一处无症状性缺血性脑损伤（p > 0.99）。无症状性缺血性脑损伤的存在与年龄有关（p = 0.03），但与AF类型无关（p = 0.77）。在30例无卒中危险因素的AF患者中有5例（13%）、108例有卒中危险因素的AF患者中有25例（25%）检测到至少一处脑微出血（p = 0.2）。脑微出血的存在与男性性别（p = 0.04）或外周动脉闭塞性疾病（p = 0.03）有关。
在计划进行消融的有症状AF患者中，脑部MRI在约十二分之一的患者中检测到无症状性缺血性脑损伤，在五分之一的患者中检测到脑微出血。有无其他卒中危险因素的AF患者中无症状性缺血性脑损伤的患病率无差异。
