Abstract 10921: Differences in Prevalence and Risk Factors of Silent Brain Infarction Between Patients With Paroxysmal and Persistent Nonvalvular Atrial Fibrillation.

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العنوان:	Abstract 10921: Differences in Prevalence and Risk Factors of Silent Brain Infarction Between Patients With Paroxysmal and Persistent Nonvalvular Atrial Fibrillation.
المؤلفون:	Tamura, Soichiro¹ (AUTHOR), Iwata, Shinichi¹ (AUTHOR), Ishikawa, Sera¹ (AUTHOR), Kitada, Ryoko¹ (AUTHOR), Kawai, Yu¹ (AUTHOR), Nonin, Shinichi¹ (AUTHOR), Ito, Asahiro¹ (AUTHOR), Doi, Atsushi¹ (AUTHOR), Izumiya, Yasuhiro¹ (AUTHOR), Yoshiyama, Minoru¹ (AUTHOR)
المصدر:	Circulation. 2018 Supplement, Vol. 138, pA10921-A10921. 1p.
مصطلحات موضوعية:	CEREBRAL infarction, ATRIAL fibrillation, DISEASE risk factors, LOGISTIC regression analysis, TRANSESOPHAGEAL echocardiography, KIDNEY diseases, *STROKE
مستخلص:	Introduction: Although silent brain infarction (SBI) is an independent risk factor for subsequent symptomatic stroke and dementia in patients with nonvalvular atrial fibrillation (NVAF), little is known regarding the differences in prevalence and risk factors of SBI between patients with paroxysmal and persistent NVAF. Methods: This study population consisted of 190 neurologically asymptomatic patients (mean age, 64 ± 11 years) with NVAF (119 paroxysmal and 71 persistent) who were scheduled for catheter ablation. All patients underwent brain magnetic resonance imaging to screen for SBI prior to the day of ablation. Comprehensive transthoracic and transesophageal echocardiography were performed to evaluate left atrial abnormalities such as left atrial enlargement, spontaneous echo contrast, or left atrial appendage emptying velocity (LAAEV) and complex plaques in the aortic arch defined as large (≥4mm), ulcerated, or mobile plaques. Results: SBI was detected in twenty-six (22%) paroxysmal and twenty-four (34%) persistent NVAF, and there were no significant difference between AF types (P = 0.09).In univariate analysis, CHA2DS2-VASc score and decreased estimated glomerular filtration rate (eGFR), e', and LAAEV were significantly associated with SBI in paroxysmal NVAF, whereas only CHA2DS2-VASc score and decreased e' were associated with SBI in persistent NVAF. Multiple logistic regression analysis indicated that presence of chronic kidney disease (eGFR < 60mL/min/1.73m2) was associated with the presence of SBI in paroxysmal NVAF (odds ratio, 3.42; 95% CI, 1.06-11.03; P < 0.05), whereas decreased e' predicted for SBI in persistent NVAF (odds ratio, 0.71; 95% CI, 0.52-0.98; P < 0.05). Conclusions: In paroxysmal NVAF, renal impairment, which represents microvascular disease, is associated with SBI independent of CHA2DS2-VASC score. In persistent NVAF, decreased e', which represents diastolic dysfunction carrying a greater risk of microembolism, is associated with SBI independent of CHA2DS2-VASC score. These findings, suggesting the different mechanism of SBI in paroxysmal (microvascular disease) and persistent (microembolism) NVAF, may be useful for risk stratification of the early stage of cerebral damage in patients with paroxysmal and persistent NVAF. [ABSTRACT FROM AUTHOR]
قاعدة البيانات:	Academic Search Index

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