Linking atrial fibrillation to cerebral small vessel disease: a cross-sectional study with predictive analytics

Atrial fibrillation (AF) and cerebral small vessel disease (CSVD) are prevalent in older adults and may synergistically contribute to cognitive decline and stroke risk. This study investigates the association between AF and CSVD markers, including white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), lacunes, and silent brain infarcts, focusing on sex-specific patterns, anticoagulation status, and predictive modeling.

In a cross-sectional study of 923 individuals aged ≥70 years undergoing 3.0-Tesla brain MRI, AF was identified via ECG, self-reports, and hospital records. CSVD markers were quantified using standardized MRI protocols. Regression models, adjusted for demographic and vascular risk factors, assessed associations between AF and CSVD markers, stratified by sex, anticoagulation status, and AF onset age. Random Forest and logistic regression models predicted high WMH burden and stroke risk.

Of 923 participants, 85 (9.2%) had AF. AF was associated with higher WMH volumes (adjusted mean: 0.0046 vs. 0.0034 mL/TIV, p = 0.051; approaching statistical significance), particularly in men (p = 0.072) and in participants receiving anticoagulation therapy (p = 0.007). AF increased odds of symptomatic stroke (OR: 4.2, 95% CI: 2.0-8.8), large infarcts, lacunes, and silent infarcts, with stronger effects in men. Frontal lobe CMBs were more prevalent in men with AF (OR: 3.9, p = 0.049). Predictive models showed high accuracy for WMH burden (81.2%, AUC-ROC: 0.88) and stroke (84.9%, AUC-ROC: 0.91).

AF is independently associated with CSVD, particularly in men and anticoagulated individuals, emphasizing the need for targeted strategies to mitigate AF-related brain injury.