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Thromb Haemost 2014; 112(06): 1312-1318
DOI: 10.1160/th14-02-0176
New Technologies, Diagnostic Tools and Drugs
Schattauer GmbH

Differential impact of unrecognised brain infarction on stroke outcome in non-valvular atrial fibrillation

Tae-Jin Song
1   Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
2   Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
,
Jinkwon Kim
3   Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
,
Hye Sun Lee
4   Departments of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
,
Chung Mo Nam
4   Departments of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
,
Hyo Seok Nam
1   Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
,
Eun Hye Kim
1   Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
,
Ki Jeong Lee
1   Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
,
Dongbeom Song
1   Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
,
Ji Hoe Heo
1   Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
,
Young Dae Kim
1   Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
› Author Affiliations Financial support: This work was supported by a grant of the Korea Healthcare Technology R&D Project through the Korean Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI10C2020).
Further Information

Publication History

Received: 26 February 2014

Accepted after major revision: 30 July 2014

Publication Date:
18 November 2017 (online)

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Summary

There has been little information regarding the impact of unrecognised brain infarctions (UBIs) on stroke outcome in patients with nonvalvular atrial fibrillation (NVAF). By using volumetric analysis of ischaemic lesions, we evaluated the potential impact of UBIs on clinical outcome according to their presence and categorised type. This study enrolled 631 patients with NVAF having no clinical stroke history. UBIs were categorised into three types as territorial, lacunar, or subcortical. We collected stroke severity, functional outcome at three months, and the total volume of UBIs and acute infarction lesions. We investigated the association between clinical outcome and the type or volume of UBI, using a linear mixed model and logistic regression analysis. UBIs were detected in 285 (45.2 %) patients; territorial UBIs were observed in 24.4 % of patients (154/631), lacunar UBIs in 25 % (158/631), and subcortical UBIs in 15.7 % (99/631). Although initial stroke severity was not different between patients with UBIs and those without, those with UBIs had less improvement during hospitalisation, leading to poorer outcome at three months. Among the three types of UBIs, only territorial UBIs were associated with poor outcome, especially in patients with relatively smaller acute infarction volume. UBIs, in particular, territorial UBIs, may be considered as predictors for poor outcome after ischaemic stroke in patients with NVAF. Our results suggest that the impact of UBIs on clinical outcome differs according to the type of UBIs and the acute stroke severity.

Keywords

Unrecognised brain infarction - non-valvular atrial fibrillation - outcome

 

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