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Atrial fibrillation is associated with decreased total cerebral blood flow and brain perfusion
Marianna Gardarsdottir1, Sigurdur Sigurdsson2, Thor Aspelund2,3
1Department of Radiology, Landspitali-The National University Hospital of Iceland, Hringbraut, 101 Reykjavik, Iceland.
Insights
Persistent atrial fibrillation (AF) significantly reduces cerebral blood flow and brain perfusion in elderly individuals. This finding highlights a potential mechanism linking AF to cognitive impairment and reduced brain volume.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Medical Imaging
Background:
- Atrial fibrillation (AF) is linked to cognitive impairment and reduced brain volume.
- Potential causes include cerebral micro-embolism or reduced stroke volume due to AF's irregular heartbeat.
Purpose of the Study:
- To measure cerebral blood flow (CBF) and estimate whole brain perfusion in elderly individuals.
- To compare CBF and brain perfusion between individuals with and without AF.
Main Methods:
- Phase contrast MRI was used to measure cervical artery blood flow in 2291 elderly participants (mean age 79.5 years).
- Participants were categorized into three groups: persistent AF, paroxysmal AF (in sinus rhythm during imaging), and no history of AF.
- Brain perfusion was estimated using MRI data.
Main Results:
- Individuals with persistent AF (n=117) had significantly lower total cerebral blood flow (472.1 mL/min) compared to paroxysmal AF (512.3 mL/min) and no AF (541.0 mL/min) groups.
- Brain perfusion was lowest in the persistent AF group (46.4 mL/100g/min) versus paroxysmal AF (50.9 mL/100g/min) and no AF (52.8 mL/100g/min) groups.
- Persistent AF group had lower cholesterol and higher use of antihypertensive medication and warfarin.
Conclusions:
- Persistent AF is associated with decreased cerebral blood flow.
- Persistent AF also leads to reduced brain tissue perfusion compared to sinus rhythm.
- These findings suggest a direct vascular mechanism linking AF to brain health.
Aims:
Atrial fibrillation (AF) has been associated with cognitive impairment. Additionally, brain volume may be reduced in individuals with AF. Potential causes may include cerebral micro-embolism or reduced stroke volume due to the beat-to-beat variation in AF. The aims of this study were to measure cerebral blood flow and estimate whole brain perfusion in elderly individuals with and without AF.
Methods And Results:
Blood flow in the cervical arteries was measured with phase contrast MRI and brain perfusion estimated in a large cohort from the AGES-Reykjavik Study. Individuals were divided into three groups at the time of the MRI: persistent AF, paroxysmal AF, and no history of AF. Of 2291 participants (mean age 79.5 years), 117 had persistent AF and 78 had paroxysmal AF but were in sinus rhythm at the time of imaging AF. Those with persistent AF had lower cholesterol and used more anti-hypertensive medication and warfarin. The three groups were similar with regard to other cardiovascular risk factors. Those in the persistent AF group had significantly lower total cerebral blood flow on average, 472.1 mL/min, both when compared with the paroxysmal AF group, 512.3 mL/min (P < 0.05) and the no AF group, 541.0 mL/min (P < 0.001). Brain perfusion was lowest in the persistent AF group, 46.4 mL/100 g/min compared with the paroxysmal AF group, 50.9 mL/100 g/min in (P < 0.05) and those with no AF, 52.8 mL/100 g/min (P < 0.001).
Conclusion:
Persistent AF decreases blood flow to the brain as well as perfusion of brain tissue compared with sinus rhythm.
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