Stroke risk prediction with cortical microinfarcts in patients with atrial fibrillation
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AbstractBackground - Cortical microinfarcts (CMI) detected by MRI brain, is a recently emerged radiological marker, representing microscopic regions of ischaemic-related cell death at brain cortex. They are most commonly observed in patients with small vessel disease, vascular dementia, Alzheimer’s disease, lacunar strokes and cerebral amyloid angiopathy. Recent studies have also demonstrated their association with subclinical cardiac diseases. However, it remains uncertain if CMI can help predict stroke risk in patients with AF. The purpose of this study is to evaluate if CMI is associated with clinical ischaemic stroke or transient ischaemic attack (IS/TIA) in patients with AF.

Methods - In this prospective multicenter study, we recruited AF patients on oral anticoagulants for 3T MRI brain. Presence of CMI was correlated with other small vessel disease markers and IS/TIA.

Results - A total of 517 patients were included in this study. CMIs were observed in 58 (11.2%) of patients. Patients with CMIs were more likely to have IS/TIA (82.8% vs 65.8%, p = 0.001) and higher mean CHA2DS-VASc score (5.26±1.86 vs 4.64±1.81, p=0.020) compared to patient without CMI. From multiple logistic regression, CMI, white matter score, hyperlipidaemia, hypertension and CHA2DS2-VASc scores were independent predictors for IS/TIA. Comparing to CHA2DS2-VASc scores alone, combining CMI with CHA2DS2-VASc scores improves risk prediction modestly for IS/TIA.

Conclusions - This proof-of-concept study suggests that CMI may help predict stroke risk in patients with AF. CMI may serve as an adjunctive risk-stratification tool when decision for anticoagulation is difficult base on clinical risk factors alone.
All Author(s) ListY Soo, J Abrigo, KT Leung, SF Tsang, V Ip, K Ma, SH Ma, V Liu, B Lam, WC Fong, SH Li, R Li, PW Ng, J Fok, KK Wong, W Chu, L Wong, V Mok, T Leung
Name of Conference4th European Stroke Organization Conference
Start Date of Conference16/05/2018
End Date of Conference18/05/2018
Place of ConferenceGothenburg
Country/Region of ConferenceSweden
Year2018
LanguagesEnglish-United Kingdom
KeywordsCortical microninfarcts, stroke, atrial fibrillation

Last updated on 2018-08-10 at 14:15