White matter integrity of watershed areas is potentially influenced by hypoperfusion in the presence permanent atrial fibrillation

P M Krupenin,V A Perepelov,E M Perepelova,I S Preobrazhenskaya,D A Napalkov,E V Sidorov,S P Bordovsky,O N Voskresenskaya,A A Sokolova

doi:10.15829/1728-8800-2021-2915

Abstract

Aim. To test a hypothesis of hypoperfusion-induced white matter changes in patients with atrial fibrillation (AFib) and to present statistics to compute sample size for the upcoming studies.Material and methods. We included 30 inpatients with AFib and investigated them with magnetic resonance imaging (MRI) with standard sequencies and diffusion tensor imaging (DTI). DTI data were analyzed with conventional ROI analysis in the Olea Sphere software and with watershed areas (WSA) mask in the FSL toolbox after nonlinear transformation of images to the Montreal Neurological Institute (MNI) space. Wilcoxon test was used to compare diffusion characteristics across subgroups.Results. Median age of participants was 73 years (69-78), 18 (60%) patients had moderate signs of small vessel disease with Fazekas score of one. Twenty-one patients had paroxysmal AFib. Analysis of WSA revealed decreased white matter integrity in the parieto-occipital cortical WSA with a pattern of significantly increased mean diffusivity (p=0,039), and marginally significant decrease in fractional anisotropy (p=0,056). Rank-based effect size across areas under comparison was either small (0,2) or negligible, and with statistical power in the range of 0,05-1.Conclusion. Atrial fibrillation could have pathophysiologically feasible mechanism to affect white matter integrity in the watershed areas.

Highlights

Atrial fibrillation (AFib) imposes the greatest so cioeconomic burden among other types of arrhythmias [1]
AFib may result in cardioembolic stroke but may alter brain perfusion and lead to small vessel disease (SVD)
We evaluated patients admitted to Sechenov Hospital #1 for management of Afib

Summary

Introduction

Atrial fibrillation (AFib) imposes the greatest so cioeconomic burden among other types of arrhythmias [1]. It significantly contributes to the risk of cerebral and myocardial infarction and decreases quality of life. AFib may result in cardioembolic stroke but may alter brain perfusion and lead to small vessel disease (SVD). There are certain brain regions that are the most susceptible to ischemia due to unique properties of their arterial supply. These zones are located between the distal parts of two arteries which have no anastomosis. The lower perfusion pressure in this region defines the higher susceptibility to ischemia. The presence of microemboli and their derivates within the watershed areas in the autopsy series proves the association between the embolic events and deve lopment of infarction in vulnerable zones [2]

Methods

Results

Discussion

Conclusion