Microbleeds in patients with heart failure and atrial fibrillation
B Voegeli, M Coslovsky, G Moschovitis, S Stagliano, L Brockhus, N Rodondi, J H Beer, T Reichlin, P Badertscher, C Sticherling, F Mahfoud, D Conen, S Osswald, M Kuehne, P KrisaiAbstract
Background
Cerebral microbleeds (CMBs) are magnetic resonance imaging (MRI) identifiable indicators of cerebral small vessel disease and are associated with adverse neurological and cardiovascular outcomes. Atrial fibrillation (AF) and heart failure (HF) share vascular risk profiles and frequently require antithrombotic therapy, yet their combined association with CMBs remains unclear.
Purpose
We aimed to investigate the associations of HF and AF, and their interaction, with MRI-detected CMBs in the Swiss-AF study.
Methods
We analyzed participants from the prospective, multicenter Swiss-AF cohort. Individuals with or without AF underwent standardized brain MRI. CMBs were identified by a central core laboratory. Participants were grouped by AF and HF status, creating four groups: AF−/HF−, AF−/HF+, AF+/HF−, and AF+/HF+. Associations were evaluated using hurdle regression models accounting for the zero-inflated distribution of CMBs. Models were adjusted for age, sex, cardiovascular risk factors, and medication use.
Results
Of 2,712 participants a total of 822 (30.3%) participants were categorized as AF−/HF−, 149 (5.5%) as AF−/HF+, 1,362 (50.2%) as AF+/HF−, and 379 (14%) as AF+/HF+. Mean age was 73±8 years and 30.8% were female. 74.2% of patients had no CMBs, 15.0% had one, and 8.5% had ≥2 lesions. CMB prevalence was highest in AF-/HF+ (35.6%) and lowest in AF+/HF- (20.4%) (Figure 1). An interaction between AF and HF was not supported (p=0.69). HF was associated with a higher prevalence of CMBs (OR 1.41, 95% CI 1.12–1.77, p<0.01), while AF showed an inverse association (OR 0.68, 95% CI 0.49–0.95, p=0.02). Older age, male sex, higher systolic blood pressure, and previous stroke/TIA were also associated with higher CMB prevalence. Neither HF nor AF was associated with higher CMB counts among those with ≥1 lesion. Male sex (OR 1.49, 95% CI 1.02–2.17 p=0.04) was associated with higher lesion burden, whereas oral anticoagulation was inversely associated (OR 0.45, 95% CI 0.28–0.73 p<0.01).
Conclusion
HF was associated with higher CMB prevalence, whereas AF demonstrated an inverse relationship. The absence of interaction suggests distinct pathophysiological mechanisms linking these conditions to cerebral small vessel disease.Graphical abstract