TY - JOUR
T1 - High prevalence of subclinical cerebral infarction in patients with heart failure with preserved ejection fraction
AU - Cogswell, Rebecca J.
AU - Norby, Faye L.
AU - Gottesman, Rebecca F.
AU - Chen, Lin Y.
AU - Solomon, Scott
AU - Shah, Amil
AU - Alonso, Alvaro
N1 - Funding Information:
The Atherosclerosis Risk in Communities (ARIC) Study is carried out as a collaborative study supported by National Heart, Lung and Blood Institute (NHLBI) contracts (HHSN2682 01100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN26820110 0010C, HHSN268201100011C, and HHSN268201100012C). Neurocognitive data are collected by U01 HL096812, HL096814, HL096899, HL096902, HL096917 from the NHLBI and the National Institute of Neurological Disorders and Stroke, and with previous brain magnetic resonance imaging examinations funded by R01-HL70825 from the NHLBI. The authors thank the staff and participants of the ARIC Study for their important contributions.
Funding Information:
This work was supported by Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) funding (U01 HL096902) and by the American Heart Association (grant 16EIA26410001). Conflict of interest: A.S. receives research support from Novar-tis, Gilead and Actelion. The other authors have nothing to declare.
Publisher Copyright:
© 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology
PY - 2017/10
Y1 - 2017/10
N2 - Aims: Undetected atrial fibrillation (AF) may be common in the heart failure with preserved ejection fraction (HFpEF) population, and failure to detect this may lead to the missing of opportunities to prevent associated subclinical cerebral infarctions (SCIs) and cognitive decline. Methods and results: We studied 1527 participants in the Atherosclerosis Risk in Communities (ARIC) Study, who underwent echocardiography, brain magnetic resonance imaging (MRI) and detailed cognitive assessment during 2011–13. Prevalences of SCI as detected by brain MRI were compared among the following groups: participants with no HFpEF/no AF; those with no HFpEF/AF; those with HFpEF/no AF, and those with HFpEF/AF. Cognitive scores were also compared. Prevalences of HFpEF and AF in this sample were 13.2% and 5.7%, respectively. Participants with HFpEF but no prior diagnosis of AF had a high prevalence of SCI by brain MRI (29.3%), which was similar to those in the no HFpEF/AF (24.5%) and HFpEF/AF (23.5%) groups, but higher than that in the no HFpEF/no AF subjects (17.3%). The odds of having SCI were higher in participants with HFpEF/no AF than in the no HFpEF/no AF group even after adjustment for potential confounders (odds ratio 1.56, 95% confidence interval 1.06–2.30). Individuals with HFpEF and SCI had lower cognitive scores than the reference (no HFpEF/no SCI) and HFpEF/no SCI groups. Conclusions: Subclinical cerebral infarctions were prevalent in subjects in the ARIC cohort with HFpEF and no prior AF diagnosis and are associated with measurable cognitive deficits. Although other sources of emboli may be possible, these data suggest that paroxysmal AF may be underdiagnosed in this population. There may be a role for earlier anticoagulation in patients with HFpEF.
AB - Aims: Undetected atrial fibrillation (AF) may be common in the heart failure with preserved ejection fraction (HFpEF) population, and failure to detect this may lead to the missing of opportunities to prevent associated subclinical cerebral infarctions (SCIs) and cognitive decline. Methods and results: We studied 1527 participants in the Atherosclerosis Risk in Communities (ARIC) Study, who underwent echocardiography, brain magnetic resonance imaging (MRI) and detailed cognitive assessment during 2011–13. Prevalences of SCI as detected by brain MRI were compared among the following groups: participants with no HFpEF/no AF; those with no HFpEF/AF; those with HFpEF/no AF, and those with HFpEF/AF. Cognitive scores were also compared. Prevalences of HFpEF and AF in this sample were 13.2% and 5.7%, respectively. Participants with HFpEF but no prior diagnosis of AF had a high prevalence of SCI by brain MRI (29.3%), which was similar to those in the no HFpEF/AF (24.5%) and HFpEF/AF (23.5%) groups, but higher than that in the no HFpEF/no AF subjects (17.3%). The odds of having SCI were higher in participants with HFpEF/no AF than in the no HFpEF/no AF group even after adjustment for potential confounders (odds ratio 1.56, 95% confidence interval 1.06–2.30). Individuals with HFpEF and SCI had lower cognitive scores than the reference (no HFpEF/no SCI) and HFpEF/no SCI groups. Conclusions: Subclinical cerebral infarctions were prevalent in subjects in the ARIC cohort with HFpEF and no prior AF diagnosis and are associated with measurable cognitive deficits. Although other sources of emboli may be possible, these data suggest that paroxysmal AF may be underdiagnosed in this population. There may be a role for earlier anticoagulation in patients with HFpEF.
KW - Atrial fibrillation
KW - Cognitive impairment
KW - Diastolic heart failure
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U2 - 10.1002/ejhf.812
DO - 10.1002/ejhf.812
M3 - Article
C2 - 28738140
AN - SCOPUS:85030693913
SN - 1388-9842
VL - 19
SP - 1303
EP - 1309
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 10
ER -