Silent brain infarctions in patients with acute cardioembolic stroke

Imane Najmi; Soumaya Benmaamar; Sara Zejli; Siham Bouchal; Samira El Fakir; Karima El Rhazi; Mohammed Faouzi Belahsen

doi:10.1016/j.jdmv.2024.02.003

Silent brain infarctions in patients with acute cardioembolic stroke

J Med Vasc. 2024 Apr;49(2):80-89. doi: 10.1016/j.jdmv.2024.02.003. Epub 2024 Mar 7.

Authors

Imane Najmi¹, Soumaya Benmaamar², Sara Zejli³, Siham Bouchal⁴, Samira El Fakir², Karima El Rhazi², Mohammed Faouzi Belahsen⁴

Affiliations

¹ Department of Neurology, Hassan II University Hospital Center, Fez, Morocco; Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco. Electronic address: imanenajmifmpf@gmail.com.
² Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco.
³ Department of Neurology, Hassan II University Hospital Center, Fez, Morocco.
⁴ Department of Neurology, Hassan II University Hospital Center, Fez, Morocco; Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco.

PMID: 38697714
DOI: 10.1016/j.jdmv.2024.02.003

Abstract

Introduction and aim: The advances and the wide use of brain imaging have considerably increased the prevalence of silent brain infarctions (SBI). We aim in this study to determine the prevalence of SBI in patients presenting with acute cardioembolic stroke and the predictive cardiovascular risk factors.

Methods: This retrospective study included 267 patients presenting with acute cardioembolic stroke in the emergency and/or neurology departments of the Hassan II University Hospital Center. Clinical, biological and echocardiographic characteristics were recorded. All patients were screened for SBI by brain imaging.

Results: The prevalence of SBI in our series was 46%. A group of 203 non-valvular patients and a group of 64 valvular patients were distinguished. In non-valvular group, the average age was 72.97±10.53years. The prevalence of SBI was 45.3%. Forty-four percent of patients with SBI had atrial fibrillation (AF). In multivariate regression analysis, the history of previous stroke, CHA₂DS₂-VASc Score≥4, enlarged left atrium (LA), the association of AF with enlarged LA and the lability of International Normalized Ratio in patients initially treated with anticoagulants were significantly associated with the occurrence of SBI (P=0.013, P=0.032, P=0.0001, P=0.01, P=0.03, respectively). Territorial location was significantly the most frequent (P=0.007). In valvular group, the average age was 57.19±14.38years. The prevalence of SBI was 48.4%. In multivariate regression analysis, SBI were significantly associated with moderate or severe mitral stenosis (P=0.02) and with the enlarged LA (P=0.02). In all patients, Modified Rankin Scale at 3 months of discharge from the acute stroke was significantly higher (mRS≥3) in patients with SBI (P=0.04).

Conclusions: SBI requires good management of associated cardiovascular risk factors in a population presenting with initial cardioembolic stroke.

Keywords: Acute cardioembolic stroke; Brain imaging; Cardioembolic risk factors; Silent brain infarctions.

MeSH terms

Aged
Aged, 80 and over
Asymptomatic Diseases
Atrial Fibrillation / complications
Atrial Fibrillation / diagnosis
Atrial Fibrillation / epidemiology
Brain Infarction* / diagnostic imaging
Brain Infarction* / epidemiology
Brain Infarction* / etiology
Embolic Stroke* / diagnostic imaging
Embolic Stroke* / epidemiology
Embolic Stroke* / etiology
Female
Humans
Male
Middle Aged
Multivariate Analysis
Prevalence
Retrospective Studies
Risk Factors