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Updated: Mar 19, 2026

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation

Published on: July 20, 2022

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Atrial Fibrillation, Congestive Heart Failure, and the Middle Cerebral Artery

S F Ameriso1, P Sager2, M Fisher3

  • 1Department of Neurology University of Southern California School of Medicine Los Angeles, CA.

Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging
|June 17, 2016
PubMed

Insights

Atrial fibrillation and congestive heart failure significantly alter brain blood flow, suggesting non-embolic stroke mechanisms. These conditions impact middle cerebral artery velocities and pulsatility, offering insights into intracranial hemodynamics.

Area of Science:

  • Neurology
  • Cardiology
  • Medical Imaging

Background:

  • Atrial fibrillation (AF) and congestive heart failure (CHF) are established risk factors for ischemic stroke.
  • Cerebral embolism is the commonly attributed cause, but alternative mechanisms warrant investigation.
  • Understanding intracranial hemodynamic changes is crucial for stroke risk stratification in these patient groups.

Purpose of the Study:

  • To investigate potential non-embolic mechanisms of ischemic stroke in patients with AF and CHF.
  • To analyze middle cerebral artery (MCA) blood flow velocities and pulsatility index in neurologically asymptomatic patients.
  • To differentiate hemodynamic profiles between valvular and nonvalvular atrial fibrillation.

Main Methods:

  • Transcranial Doppler (TCD) ultrasound was used to assess MCA blood flow velocities.
  • Patient groups included nonvalvular AF (n=10), valvular AF (n=13), CHF in normal sinus rhythm (n=13), and healthy controls (n=11).
  • Analysis focused on beat-to-beat variations in peak, mean, and diastolic velocities, and pulsatility index (PI).

Main Results:

  • Both AF groups exhibited significantly greater beat-to-beat velocity and PI variations compared to CHF and control groups.
  • MCA velocities (peak, mean, diastolic) were significantly reduced in AF and CHF patients versus controls.
  • Nonvalvular AF patients showed a higher PI compared to all other groups, suggesting distinct hemodynamic alterations.

Conclusions:

  • Atrial fibrillation and congestive heart failure induce significant, non-embolic alterations in intracranial circulation.
  • These hemodynamic changes in MCA blood flow may contribute to ischemic stroke risk independent of embolism.
  • The observed intracranial hemodynamic profile may help distinguish between valvular and nonvalvular atrial fibrillation.

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