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Clinical-Medical Image - International Journal of Clinical & Medical Images (2022) Volume 9, Issue 10
Author(s): Alves Ayadi*
Department of Cardiology, University of Calgary, Canada, USA
Date of Submission: 03 October 2022, Manuscript No. ijcmi-23-88666; Editor assigned: 05 October 2022, Pre QC No. P-88666; Reviewed: 18 October 2022, QC No. Q-88666; Revised: 21 October 2022, Manuscript No. R-88666; Published: 28 October 2022, DOI: 10.4172/2376-0249.1000854
Citation: Ayadi A. (2022) Functions in Persistent Atrial Fibrillation. Int J Clin Med Imaging 9:854.
Copyright: © 2022 Ayadi A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Atrial fibrillation (AF) is the most prevalent arrhythmia and represents a global health burden. Emerging risk factors, a prolonged life span, and expanded screening have contributed to the increasing incidence of AF, particularly in developed countries. Due to the substantial morbidity and mortality, different public health measures have been established to improve the diagnosis and management of these patients. A particular focus has been put on the prevention of acute ischemic stroke, with the CHA2DS2VASc (congestive heart failure, hypertension, age, diabetes mellitus, previous stroke, vascular disease, and sex category) score being the cornerstone of risk stratification and preventative anticoagulation management.
It has been suggested that AF is associated with neuronal injury and cognitive impairment, irrespective of the previous stroke or co-existing comorbidities. Several contributing mechanisms have been proposed, including genetic factors, cerebral hypo perfusion, systemic inflammation, and silent cerebral ischemia mediated by subclinical micro emboli. Furthermore, emerging evidence has demonstrated flow disturbances in AF patients that may disrupt the blood-brain barrier (BBB), thereby exposing the central nervous system to injury with variable degrees of cognitive and psychomotor decline.
Previous studies have shown that magnetic resonance imaging (MRI) can detect small vascular and non-vascular brain lesions in patients with AF. Even in patients without clinically evident stroke, large cortical or non-cortical infarcts, small non-cortical infarcts, micro bleeds, and white-matter hyper intensities have been demonstrated. Nevertheless, the clinical significance of such isolated findings is questionable, and the importance of comprehensive screening tools that include different neuroimaging, neurocognitive, and laboratory tests has been emphasized.
There is an increasing interest in neurologic biomarkers that could be potentially used for both risk stratification and diagnostic testing in an AF population. Recent studies have suggested that the disruption of the BBB could induce the peripheral release of markers of neuronal injury, such as glial fibrillary acidic protein (GFAP) and serum neuro filament light protein (NFL). Ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) is an additional emerging biomarker that is specific to the central nervous system but can be found in the peripheral circulation after a traumatic brain injury. Although there are individual studies investigating GFAP and NFL, there are no comprehensive data evaluating all aforementioned neurologic biomarkers in an AF population, including their association with electrical cardio version [1-3].
Therefore, the goal of this study was to determine plasma levels of specific neurologic biomarkers (GFAP, NFL, and UCH-L1), neuroimaging findings, and cognitive function in patients with persistent AF undergoing electrical cardio version and compare them to those in control patients. Furthermore, this study investigated the dynamics of these biomarkers regarding electrical cardio version in AF patients.
Co-existing neuronal injury in patients with AF may manifest as cognitive or psychomotor impairment. The present study did not reveal statistically significant differences in cognitive function or selected neurologic biomarkers between the AF patients and the control subjects. However, this study did not use an MRI of the brain, and it is possible that some patients had silent cerebral lesions that could have affected the results.
Atrial fibrillation; Cognition; MRI
[1] Lip GY, Nieuwlaat R, Pisters R, Lane D A. (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: The euro heart survey on atrial fibrillation. Chest 137: 263-272.
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[2] Conen D, Rodondi N, Muller A, Beer JH. (2019) Relationships of overt and silent brain lesions with cognitive function in patients with atrial fibrillation. J Am Coll Cardiol 73: 989-999.
[3] Chugh SS, Havmoeller R, Narayanan K, Singh D. (2014) Worldwide epidemiology of atrial fibrillation: A global burden of disease 2010 study. Circulation 129: 837-847.
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