Ischemic brain infarcts, white matter hyperintensities, and cognitive impairment are increased in patients with Atrial Fibrillation

Article Article scientifique Article Ischemic brain infarcts, white matter hyperintensities, and cognitive impairment are increased in patients with Atrial Fibrillation eng 2026-01-27 author Krisai Philipp 0000-0002-4367-2363 Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland. philipp.krisai@usb.ch.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland. philipp.krisai@usb.ch. author Aeschbacher Stefanie Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland. author Coslovsky Michael 0000-0001-7678-7354 Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.,Department of Clinical Research, University Basel, University Hospital Basel, Basel, Switzerland. author Rommers Nikki 0000-0003-0311-5009 Department of Clinical Research, University Basel, University Hospital Basel, Basel, Switzerland. author Reichlin Tobias Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. author Müller Andreas S 0000-0001-7845-9012 Department of Cardiology, Triemli Hospital Zürich, Zürich, Switzerland. author Beer Jürg H 0000-0002-7199-0406 Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Zürich, Switzerland. author Ammann Hans-Peter Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland. 80656 author Auricchio Angelo Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Cardiocentro Ticino Institute, Regional Hospital of Lugano, Lugano, Switzerland. author Moschovitis Giorgio 0000-0002-4043-8061 Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Cardiocentro Ticino Institute, Regional Hospital of Lugano, Lugano, Switzerland. author Kobza Richard Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland. author Shah Dipen Division of Cardiology, Department of Medical Specialities, University Hospital Geneva, Geneva, Switzerland. 559124 Département de médecine (DEMED) author Di Valentino Marcello Division of Cardiology, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland. author Conte Giulio Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Cardiocentro Ticino Institute, Regional Hospital of Lugano, Lugano, Switzerland. author Ehret Georg Benedikt Division of Cardiology, Department of Medical Specialities, University Hospital Geneva, Geneva, Switzerland. 98462 Département de médecine (DEMED) author Hennings Elisa 0000-0003-2616-5535 Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland. author Monsch Andreas Memory Clinic, Universitäre Altersmedizin, Felix Platter Spital Basel, University of Basel, Basel, Switzerland. author Paladini Rebecca E Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland. author Rodondi Nicolas Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. author Roten Laurent 0000-0002-0827-1329 Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. author Schwenkglenks Matthias 0000-0001-7217-1173 Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zürich, Switzerland.,Health Economics Facility, Department of Public Health, University of Basel, Basel, Switzerland. author Sticherling Christian 0000-0001-8428-7050 Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland. author Badertscher Patrick Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland. author Zuern Christine S Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland. author Sinnecker Tim Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland.,Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland. author Duering Marco Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland. author Mahfoud Felix 0000-0002-4425-549X Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland. author Bonati Leo H 0000-0003-1163-8133 Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland.,Rheinfelden Rehabilitation Clinic, Rheinfelden, Switzerland. author Conen David Population Health Research Institute, McMaster University, Hamilton, Canada. author Osswald Stefan Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland. author Kühne Michael Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland. Swiss-AF Investigators collaborator Callet Hervé collaborator Guillermet Elise 947495 collaborator Lazeyras François 512748 collaborator Lövblad Karl-Olof 135154 Département de radiologie et informatique médicale (RADIO) collaborator Perret Patrick 39639 collaborator Tavel Philippe 120 10.1038/s43856-026-01389-w 41593217 2730-664X PMC12916941 https://www.nature.com/articles/s43856-026-01389-w Background: The interrelationships between atrial fibrillation (AF), brain lesions and cognitive function are poorly understood. We aimed to investigate the relationship of AF with brain lesions and cognition. Methods: We enrolled 1,480 patients with and 959 without AF in a multicenter prospective study (Swiss-AF; NCT02105844). We assessed brain structure, and cognition using the Montreal Cognitive Assessment (MoCA). Brain magnetic resonance imaging (MRI) was performed to assess large non-cortical and cortical infarcts (LNCCI), small non-cortical infarcts (SNCI), white matter hyperintensities (WMH), and microbleeds. Using causal mediation analyses, we investigated the direct (lesion-independent) and indirect (lesion-mediated) effects of AF on cognition. Results: Mean age in AF patients is 75.0 vs. 74.2 years in no-AF patients, 28.6% vs. 36.9% are female, and comorbidities are comparable. The prevalence of MRI-detected brain infarcts (LNCCI and/or SNCI) is 40.1% in AF patients vs. 24.0% in no-AF patients, adjusted OR (95% CI): 1.78 (1.30; 2.44), p = 0.0003. WMH (Fazekas ≥2) are more prevalent in AF patients (59.2% vs 44.4%), adjusted OR (95% CI): 2.03 (1.50; 2.77), p = 4.6e-06. The mean MoCA score is 25.3 in AF patients and 26.4 in no-AF patients. In mediation analysis, the total effect of AF on cognition is -1.05 MoCA points, decomposed into a direct effect of -0.99 and an indirect, lesion-mediated, effect of -0.06 points. Conclusions: The prevalence of ischemic brain infarcts and WMH is higher in patients with AF than without AF despite comparable comorbidities. AF is associated with lower cognitive function, primarily through a direct effect rather than mediated by brain lesions. Dewey 616.0757 Dewey 616 Swiss National Science Foundation Swiss Atrial Fibrillation Cohort Study 148474 CH Swiss National Science Foundation Swiss Atrial Fibrillation Cohort Study 177520 CH Swiss National Science Foundation Health Consequences of the Burden of Atrial Fibrillation - The Swiss-AF-Burden study 176178 CH Swiss National Science Foundation Mechanisms of cognitive decline in patients with atrial fibrillation: the Swiss AF-Brain Study 197524 CH Swiss National Science Foundation Brain lesions and cognitive function in patients with versus without atrial fibrillation 192394 CH 62 Département de radiologie et informatique médicale 227 56 Département de médecine 221 false 470 Ischémie cérébrale et connectivité 801 398 Electrophysiologie 666 560 Génétique 901 Communications medicine 6 1 11e85a2d-9c65-42ee-90af-4dd95bda9a98 Article (Published version) Public Article_scientifique_from_crossref.pdf 1207489 application/pdf CC BY-NC-ND-4.0 2a78f931c9b1faf32d85dc7ac829865826b6d4a539e519b05aade58bf77b93ab openAccess Faculté de médecine / Section de médecine clinique / Département de radiologie et informatique médicale Faculté de médecine / Section de médecine clinique / Département de médecine

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Ischemic brain infarcts, white matter hyperintensities, and cognitive impairment are increased in patients with Atrial Fibrillation	Communications medicine			2026	7	13

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Ammann, Hans-Peter