Shadi Kalantarian, MD, MPH; Hakan Ay, MD; Randy L. Gollub, MD, PhD; Hang Lee, PhD; Kallirroi Retzepi, MSc; Moussa Mansour, MD; Jeremy N. Ruskin, MD
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, the National Center for Research Resources, or the National Institutes of Health.
Acknowledgment: The authors thank W.T. Longstreth Jr., MD, MPH, from the University of Washington, Seattle, Washington, and Tsukasa Saito, MD, PhD, from Asahikawa Medical University, Hokkaido, Japan, for providing additional data from their published studies.
Grant Support: By the Deane Institute for Integrative Research in Atrial Fibrillation and Stroke, Massachusetts General Hospital, and with support from Harvard Catalyst and the Harvard Clinical and Translational Science Center (National Institutes of Health Award UL1 RR 025758 and financial contributions from Harvard University and its affiliated academic health care centers).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0538.
Requests for Single Reprints: Jeremy N. Ruskin, MD, Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Kalantarian, Mansour, and Ruskin: Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.
Drs. Ay and Gollub and Ms. Retzepi: Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 Thirteenth Street, Charlestown, MA 02129.
Dr. Lee: Department of Biostatistics, Massachusetts General Hospital, 50 Staniford Street, Boston MA 02114.
Author Contributions: Conception and design: S. Kalantarian, H. Ay, J.N. Ruskin.
Analysis and interpretation of the data: S. Kalantarian, H. Ay, R.L. Gollub, K. Retzepi, J.N. Ruskin.
Drafting of the article: S. Kalantarian, H. Ay, H. Lee, J.N. Ruskin.
Critical revision of the article for important intellectual content: S. Kalantarian, H. Ay, H. Lee, M. Mansour, J.N. Ruskin.
Final approval of the article: S. Kalantarian, H. Ay, R.L. Gollub, H. Lee, M. Mansour, J.N. Ruskin.
Provision of study materials or patients: S. Kalantarian.
Statistical expertise: H. Lee.
Administrative, technical, or logistic support: R.L. Gollub, J.N. Ruskin.
Collection and assembly of data: S. Kalantarian, K. Retzepi.
Kalantarian S, Ay H, Gollub RL, Lee H, Retzepi K, Mansour M, et al. Association Between Atrial Fibrillation and Silent Cerebral Infarctions: A Systematic Review and Meta-analysis. Ann Intern Med. 2014;161:650-658. doi: 10.7326/M14-0538
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Published: Ann Intern Med. 2014;161(9):650-658.
Atrial fibrillation (AF) is a common cause of stroke. Silent cerebral infarctions (SCIs) are known to occur in the presence and absence of AF, but the association between these disorders has not been well-defined.
To estimate the association between AF and SCIs and the prevalence of SCIs in stroke-free patients with AF.
Searches of MEDLINE, PsycINFO, Cochrane Library, CINAHL, and EMBASE from inception to 8 May 2014 without language restrictions and manual screening of article references.
Observational studies involving adults with AF and no clinical history of stroke or prosthetic valves who reported SCIs.
Study characteristics and study quality were assessed in duplicate.
Eleven studies including 5317 patients with mean ages from 50.0 to 83.6 years reported on the association between AF and SCIs. Autopsy studies were heterogeneous and low-quality; therefore, they were excluded from the meta-analysis of the risk estimates. When computed tomography (CT) and magnetic resonance imaging (MRI) studies were combined, AF was associated with SCIs in patients with no history of symptomatic stroke (odds ratio, 2.62 [95% CI, 1.81 to 3.80]; I2 = 32.12%; P for heterogeneity = 0.118). This association was independent of AF type (paroxysmal vs. persistent). The results were not altered significantly when the analysis was restricted to studies that met at least 70% of the maximum possible quality score (odds ratio, 3.06 [CI, 2.24 to 4.19]). Seventeen studies reported the prevalence of SCIs. The overall prevalence of SCI lesions on MRI and CT among patients with AF was 40% and 22%, respectively.
Most studies were cross-sectional, and autopsy studies were heterogeneous and not sufficiently sensitive to detect small lesions.
Atrial fibrillation is associated with more than a 2-fold increase in the odds for SCI.
Deane Institute for Integrative Research in Atrial Fibrillation and Stroke, Massachusetts General Hospital.
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Cardiology, Neurology, Rhythm Disorders and Devices, Stroke.
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