TY - JOUR
T1 - Sex differences of vascular brain lesions in patients with atrial fibrillation
AU - SWISS-AF Investigators
AU - Ceylan, Selinda
AU - Aeschbacher, Stefanie
AU - Altermatt, Anna
AU - Sinnecker, Tim
AU - Rodondi, Nicolas
AU - Blum, Manuel
AU - Coslovsky, Michael
AU - Evers-Dörpfeld, Simone
AU - Niederberger, Sacha
AU - Conen, David
AU - Osswald, Stefan
AU - Kühne, Michael
AU - Düring, Marco
AU - Wuerfel, Jens
AU - Bonati, Leo
AU - Conte, Giulio
N1 - © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
PY - 2022/9
Y1 - 2022/9
N2 - OBJECTIVE: To examine sex differences in prevalence, volume and distribution of vascular brain lesions on MRI among patients with atrial fibrillation (AF).METHODS: In this cross-sectional analysis, we included 1743 patients with AF (27% women) from the multicentre Swiss Atrial Fibrillation study (SWISS-AF) with available baseline brain MRI. We compared presence and total volume of large non-cortical or cortical infarcts (LNCCIs), small non-cortical infarcts, microbleeds (MB) and white matter hyperintensities (WMH, Fazekas score ≥2 for moderate or severe degree) between men and women with multivariable logistic regression. We generated voxel-based probability maps to assess the anatomical distribution of lesions.RESULTS: We found no strong evidence for an association of female sex with the prevalence of all ischaemic infarcts (LNCCI and SNCI combined; adjusted OR 0.86, 95% CI 0.67 to 1.09, p=0.22), MB (adjusted OR 0.91, 95% CI 0.68 to 1.21, p=0.52) and moderate or severe WMH (adjusted OR 1.15, 95% CI 0.90 to 1.48, p=0.27). However, total WMH volume was 17% larger among women than men (multivariable adjusted multiplicative effect 1.17, 95% CI 1.01 to 1.35; p=0.04). Lesion probability maps showed a right hemispheric preponderance of ischaemic infarcts in both men and women, while WMH were distributed symmetrically.CONCLUSION: Women had higher white matter disease burden than men, while volume and prevalence of other lesions did not differ. Our findings highlight the importance of controlling risk factors for cerebral small vessel disease in patients with AF, especially among women.
AB - OBJECTIVE: To examine sex differences in prevalence, volume and distribution of vascular brain lesions on MRI among patients with atrial fibrillation (AF).METHODS: In this cross-sectional analysis, we included 1743 patients with AF (27% women) from the multicentre Swiss Atrial Fibrillation study (SWISS-AF) with available baseline brain MRI. We compared presence and total volume of large non-cortical or cortical infarcts (LNCCIs), small non-cortical infarcts, microbleeds (MB) and white matter hyperintensities (WMH, Fazekas score ≥2 for moderate or severe degree) between men and women with multivariable logistic regression. We generated voxel-based probability maps to assess the anatomical distribution of lesions.RESULTS: We found no strong evidence for an association of female sex with the prevalence of all ischaemic infarcts (LNCCI and SNCI combined; adjusted OR 0.86, 95% CI 0.67 to 1.09, p=0.22), MB (adjusted OR 0.91, 95% CI 0.68 to 1.21, p=0.52) and moderate or severe WMH (adjusted OR 1.15, 95% CI 0.90 to 1.48, p=0.27). However, total WMH volume was 17% larger among women than men (multivariable adjusted multiplicative effect 1.17, 95% CI 1.01 to 1.35; p=0.04). Lesion probability maps showed a right hemispheric preponderance of ischaemic infarcts in both men and women, while WMH were distributed symmetrically.CONCLUSION: Women had higher white matter disease burden than men, while volume and prevalence of other lesions did not differ. Our findings highlight the importance of controlling risk factors for cerebral small vessel disease in patients with AF, especially among women.
KW - Atrial Fibrillation/complications
KW - Brain/diagnostic imaging
KW - Cross-Sectional Studies
KW - Female
KW - Humans
KW - Infarction/complications
KW - Male
KW - Sex Characteristics
UR - http://www.scopus.com/inward/record.url?scp=85141773086&partnerID=8YFLogxK
U2 - 10.1136/openhrt-2022-002033
DO - 10.1136/openhrt-2022-002033
M3 - Article
C2 - 36100317
VL - 9
JO - Open Heart
JF - Open Heart
SN - 2053-3624
IS - 2
M1 - e002033
ER -