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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
Atrial fibrillation reduces CSF flow dynamics. A multimodal MRI study
Sabine Hofer1, Marlena Schnieder2, Leonie Polster1
1Department of Neurology, University Medical Center Göttingen, Germany.
Insights
Atrial fibrillation (AF) disrupts the brain's waste clearance system by reducing and altering cerebrospinal fluid (CSF) flow rhythm. This suggests impaired glymphatic system function in AF patients.
Area of Science:
- Neuroscience
- Cardiology
- Medical Imaging
Background:
- Atrial fibrillation (AF) is linked to cognitive decline, but underlying mechanisms remain unclear.
- The brain's glymphatic system (GS) clears waste via cerebrospinal fluid (CSF) flow, requiring synchrony with blood flow.
- Investigating GS function in AF is crucial for understanding cognitive impairment.
Purpose of the Study:
- To examine glymphatic system function in patients with atrial fibrillation.
- To assess cerebrospinal fluid (CSF) dynamics in relation to blood flow in AF.
- To utilize a fast multimodal magnetic resonance imaging (MRI) protocol.
Main Methods:
- 13 healthy volunteers and 13 AF patients underwent 3T MRI.
- Real-time phase-contrast flow MRI captured CSF and blood flow.
- Advanced diffusion MRI techniques assessed fluid motion and whole-brain CSF dynamics.
Main Results:
- AF patients exhibited reduced and aperiodic CSF flow compared to controls.
- Lower CSF flow volume and less periodic flow patterns were observed in AF patients.
- No significant differences in brain volume, ventricular size, white matter integrity, or perivascular fluid flow were found.
Conclusions:
- Atrial fibrillation alters CSF dynamics and disrupts flow rhythmicity.
- These changes likely impair glymphatic system function.
- Further research is needed to elucidate the link between AF, GS dysfunction, and cognitive impairment.
Background:
Atrial fibrillation (AF), the most common cardiac arrhythmia, is linked to cognitive impairment and dementia but the mechanisms behind are not understood. In the brain, the glymphatic system (GS) is crucial for clearing waste from the brain through rhythmic flow of CSF. In order to ensure optimal GS function a synchrony between the dynamics of blood flow and cerebrospinal fluid (CSF) flow is necessary. Thus, our aim was to examine GS function in AF using a fast multimodal imaging protocol in a single MRI session.
Methods:
We measured 13 healthy volunteers and 13 patients with AF, using a 3T MRI system. To capture CSF and blood flow, real-time phase-contrast flow MRI was employed in the aqueduct, internal carotid artery, and jugular vein. T1-weighted imaging segmented brain tissue and ventricular size, while fast T1Flash examined tissue anatomy. EPI diffusion assessed fluid motion along the perivascular space, and artefact-free STEAM diffusion described whole-brain CSF dynamics.
Results:
The results showed that AF patients had reduced and aperiodic CSF flow compared to healthy controls, with lower flow volume and less periodic flow patterns. Anatomical parameters such as brain volume, ventricular size, white matter integrity, and perivascular fluid flow showed no significant differences between the groups.
Conclusions:
These findings suggest that AF changes CSF dynamics and disrupts its rhythmicity, likely impairing GS function.
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