November 04, 2014
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AF may double risk for silent cerebral infarction

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Atrial fibrillation was associated with a more than twofold increase in the odds for silent cerebral infarction, according to a new systematic review and meta-analysis in Annals of Internal Medicine.

The researchers’ goal was to estimate the association between AF and silent cerebral infarction and the prevalence of silent cerebral infarction in patients with AF but no stroke. They analyzed 11 studies including 5,317 patients that reported on the association between AF and silent cerebral infarction and 17 studies that reported on the prevalence of silent cerebral infarction.

Shadi Kalantarian, MD, MPH

Shadi Kalantarian

When nine studies that used CT or MRI to determine the association between AF and silent cerebral infarction (n=4,407; 505 with AF) were combined, AF was associated with silent cerebral infarction in patients with no history of symptomatic stroke (AF group, 45.54%; no AF group, 15.63%; OR=2.62; 95% CI, 1-81-3.8; I2=32.12%; P for heterogeneity=.118), Shadi Kalantarian, MD, MPH, from the Institute for Heart, Vascular and Stroke Care at Massachusetts General Hospital, and colleagues wrote.

There was no difference in the association regardless of whether a person with AF had paroxysmal AF (OR=3.83; 95% CI, 2.17-6.75; I2=0%; P for heterogeneity=.18) or permanent AF (OR=3.87; 95% CI, 2.2-6.8; I2=0%; P for heterogeneity=.32). Restricting the analysis to studies that met at least 70% of the maximum possible quality score did not change the results (OR=3.06; 95% CI, 2.24-4.19).

The prevalence of silent cerebral infarction varied by diagnostic method, according to Kalantarian and colleagues. In MRI studies, the prevalence was 40% (95% CI, 29-51). In CT studies, the prevalence was 22% (95% CI, 13-32).

Most studies did not report data on the incidence of silent cerebral infarction in patients with AF, so those data were not pooled, the researchers wrote.

“This meta-analysis suggests that silent cerebral infarctions are very common in patients with AF,” Kalantarian and colleagues wrote. “The higher prevalence of silent cerebral infarction in patients with AF may put this population at a greater risk for cognitive impairment, future stroke and disability. Additional studies are warranted to identify appropriate preventive and treatment strategies to reduce the incidence of silent cerebral infarction in patients with AF.”

Disclosure: The study was funded by the Deane Institute for Integrative Research in Atrial Fibrillation and Stroke at Massachusetts General Hospital, the NIH and Harvard University. See the full study for a list of the researchers’ relevant financial disclosures.