Covert Embolic Brain Infarcts, Remote Cortical Thinning, and Cognitive Impairment in Atrial Fibrillation: An Analysis of the Swiss-AF Cohort.
Overview
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Cardiology Division, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
- Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zurich, Zurich, Switzerland
- Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Cardiocentro Ticino Institute, Regional Hospital of Lugano, Lugano, Switzerland
- Department of Neurology, Bern University Hospital, Inselspital, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Inselspital, Bern, Switzerland
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
Abstract
Introduction: Patients with atrial fibrillation (AF) exhibit a notable prevalence of both (covert) brain infarcts and white matter hyperintensities (WMHs). They face an elevated risk of cognitive decline and dementia, yet the pathogenesis remains largely unknown. Here, we aimed to investigate a potential relationship between lesion location of embolic brain infarcts or WMHs and (i) remote cortical volume using a tract-based analysis, as well as (ii) global cognitive function using voxel-based lesion-symptom mapping.
Methods: This is a cross-sectional analysis from a prospective, multicenter cohort study of unselected patients with AF (Swiss-AF) enrolling 1,716 patients with eligible MRI data (mean age 73 ± 8 years, 27% women, 90% anticoagulated). We assessed the association of brain lesions including embolic brain infarcts and WMHs in specific white matter tracts with remote cortical volume by using LASSO regression. In addition, voxel-based lesion-symptom mapping was deployed to assess the effect of WMH location in relationship to embolic brain infarcts on cognitive function.
Results: We observed WMH in 1,699 of 1,716 (99%) and embolic brain infarcts in 395 of 1,716 (23%) patients. The presence of embolic infarcts within most fiber tracts (mean, IQR: 55, 8–66 cm3) accounted for more variability in remote cortical volumes than WMH regional volume (mean, IQR: 366, 63–657 cm3) despite their lower volume. In addition, while the presence of WMH was initially associated with cognitive function across most brain regions (61.8% of voxels with significant association), when adjusting models for the presence of embolic infarcts, only a minor fraction of WMH remained significantly associated with cognitive function (23.6% of voxels).
Conclusions: Among patients with AF, (covert) embolic brain infarcts and WMHs are associated with remote cortical atrophy and with lower cognitive performance. The disruption of brain networks through embolic infarcts seems to contribute to cognitive impairment in patients with AF.
Reproduced under the paper's license (CC BY-NC), from the paper cited above.
Code
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Data
Datasets cited
- figshare:33032309 — at figshare; found in DataCite
Data Availability Statement
We strongly encourage third-party use of Swiss-AF cohort data and collaborative, joint analyses or pooled-cohort projects in relation to our study. The de-identified dataset from the multicenter Swiss-AF cohort is not publicly available because of privacy and ethical considerations. Qualified researchers may obtain the data on reasonable request, provided they sign a data-use agreement, obtain appropriate institutional ethical approval, and agree to data-security and confidentiality requirements. Requests should be directed to the corresponding author or the Swiss-AF steering committee.
Reproduced under the paper's license (CC BY-NC), from the paper cited above.
Versions
The history of this record: each version stored by the harvester or made by a correction of its authors or of the maintainers of its code, and what changed in its facts. The texts of the paper (its abstract, its availability statements) are not part of it; versions that changed only those are not listed.
Version 2, 28 September 2026
- Publisher: — → Karger Publishers
Version 1, 27 September 2026: the first record
Recorded: type, language, journal, pages, dates, 14 authors, 4 keywords, 1 funder, 48 references.
Cite
This paper
Sinnecker, T., Aeschbacher, S., Springer, A., Coslovsky, M., Beer, J., Moschovitis, G., Fischer, U., Rodondi, N., Conen, D., Krisai, P., Kühne, M., Osswald, S., Bonati, L. H., & on behalf of the Swiss-AF study investigators. (2026). Covert Embolic Brain Infarcts, Remote Cortical Thinning, and Cognitive Impairment in Atrial Fibrillation: An Analysis of the Swiss-AF Cohort. Cerebrovascular diseases (Basel, Switzerland), 1-14. https://
BibTeX
@article{sinnecker2026co
author = {Sinnecker, Tim and Aeschbacher, Stefanie and Springer, Anne and Coslovsky, Michael and Beer, Juerg and Moschovitis, Giorgio and Fischer, Urs and Rodondi, Nicolas and Conen, David and Krisai, Philipp and Kühne, Michael and Osswald, Stefan and Bonati, Leo H. and {on behalf of the Swiss-AF study investigators}},
title = {{Covert Embolic Brain Infarcts, Remote Cortical Thinning, and Cognitive Impairment in Atrial Fibrillation: An Analysis of the Swiss-AF Cohort}},
journal = {Cerebrovascular diseases (Basel, Switzerland)},
year = {2026},
month = jul,
pages = {1--14},
publisher = {Karger Publishers},
issn = {1015-9770},
doi = {10.1159/
url = {https://
pmid = {42475254},
pmcid = {PMC13506151}
}
RIS
TY - JOUR
AU - Sinnecker, Tim
AU - Aeschbacher, Stefanie
AU - Springer, Anne
AU - Coslovsky, Michael
AU - Beer, Juerg
AU - Moschovitis, Giorgio
AU - Fischer, Urs
AU - Rodondi, Nicolas
AU - Conen, David
AU - Krisai, Philipp
AU - Kühne, Michael
AU - Osswald, Stefan
AU - Bonati, Leo H.
AU - on behalf of the Swiss-AF study investigators
TI - Covert Embolic Brain Infarcts, Remote Cortical Thinning, and Cognitive Impairment in Atrial Fibrillation: An Analysis of the Swiss-AF Cohort
T2 - Cerebrovascular diseases (Basel, Switzerland)
J2 - Cerebrovasc Dis
PY - 2026
DA - 2026/
SP - 1
EP - 14
SN - 1015-9770
PB - Karger Publishers
DO - 10.1159/
UR - https://
LA - en
ER -
CSL-JSON
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