Identificación de infartos cerebrales silentes en pacientes con fibrilación auricular mediante resonancia magnética de 3 Teslas

Abstract

Silent brain infarcts (SBI), defined as a finding on neuroimaging without neurological symptoms, are associated with a higher risk of future stroke, cognitive decline and higher mortality rates. For these reasons, SBI should be considered as an initial manifestation of cerebrovascular disease that requires secondary prevention and not only as an incidental finding. Atrial Fibrillation (AF) has been previously identified as a cause of SBI. At present, the most commonly used tools to estimate the embolic risk in patients with AF are CHADS2 and CHA2DS2VASc scores. Patients who score ≥2 are treated with oral anticoagulation (OAC) for thromboembolism prevention, but in those who score less than 2, clinical practice is not constant, and a proportion of these patients might be undertreated. For both scoring systems, a previous history of stroke or TIA scores 2 points, which means a high embolic risk and therefore, indicates starting anticoagulation. A percentage of patients with AF who score 0–1 on the CHADS2 or CHA2DS2VASc score (or 2 if 1 point is female sex) might present SBI if scanned with a high field MRI (3 Tesla, [3T]). This theoretically low to moderate risk population would not receive any treatment as stroke prevention or they would receive antiplatelet treatment. However, if an SBI is detected on an MRI, we suggest that a more aggressive prevention strategy should be implemented in this population. We hypothesize that a significant percentage of patients with AF and theoretically low/moderate embolic risk might present SBI if screened with MRI and that SBI could be associated with less adherence to a healthy lifestyle and with cognitive decline. The main aim of this study is to determine the prevalence of and risk factors for SBI in patients with AF and low/moderate embolic risk according to CHADS2 and CHA2DS2VASc. Secondary aims include to determine the association of SBI with Mediterranean diet (MeD) and physical activity and to evaluate cognitive and psychological scores in this population. Patients with a history of AF based on medical records who scored 0–1 in the CHADS2 score were selected from the Seville urban area using the Andalusian electronic healthcare database (DIRAYA). Demographic and clinical data were collected, and a 3T brain MRI was performed on patients > 50 years and with absence of neurological symptoms. Physical activity and diet habits were assessed by two validated self-administered questionnaires. Food-frequency questionnaire, biomarkers and neuropsychology were assessed in patients with SBI and controls.