Abstract WP238: Atrial Fibrillation is Associated With Severe Basal Ganglia Perivascular Spaces

Abstract

Introduction: High burdens of basal ganglia-perivascular spaces (BG-PVS) are often attributed to underlying hypertensive cerebral small vessel disease (HTN-CSVD). Although PVS are thought to arise from decreased perivascular drainage related to changes in arterial pulsatility, the contribution of pulsatility changes from nonvalvular atrial fibrillation (NVAF) has not been studied. Hypothesis: We hypothesized that NVAF patients have a higher burden of BG-PVS than HTN-CSVD patients, possibly through hemodynamic factors related to NVAF. Methods: Through an observational single-center study of consecutive stroke patients, we compared BG-EPVS severity between 136 patients with NVAF-related ischemic stroke (NVAF-IS) and 107 patients with HTN-CSVD-related intracerebral hemorrhage (HTN-ICH) without NVAF. Within the NVAF cohort, we also built multiple regression models to evaluate independent effects of NVAF-related factors on BG-PVS. All multiple regression models were adjusted for age, hypertension, sex, and neuroimaging markers of CSVD (extent of white matter hyperintensities (WMH), presence of lacunes, and cerebral microbleeds). Results: Patients with NVAF-IS were older than patients with HTN-ICH (75 + 12 vs. 64 + 13, p < 0.0001); however, there was no difference in sex between groups ( p = 0.6). Severe BG-PVS (defined as > 20 PVS in the BG) were found in 42.6% of NVAF-IS patients vs. 8.4% of HTN-ICH ( p < 0.0001). Even after multivariate adjustment, the presence of NVAF remained significantly related to BG-PVS ( p = 0.001). Within the NVAF cohort, CHA2DS2-VASc was associated with the presence of severe BG-PVS ( p = 0.003) despite controlling for other covariates. When CHA2DS2-VASc was replaced with its individual components in the same regression model, congestive heart failure (CHF, p = 0.017), WMH burden ( p = 0.009), and age ( p = 0.02) were found to be predictors of severe BG-PVS. Conclusions: Severe BG-PVS were significantly more common in NVAF patients compared to HTN-CSVD patients. NVAF-related features (CHA2DS2-VASc score) and CHF were associated with higher burdens of BG-PVS. These findings suggest that NVAF might play a role in the development of BG-PVS, conceivably through hemodynamic factors.