[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.204.108.121. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Article
November 1990

Epidemiologic Features of Asymptomatic Cerebral Infarction in Patients With Nonvalvular Atrial Fibrillation

Author Affiliations

From the Departments of Neurology (Dr Feinberg) and Radiology (Drs Seeger and Carmody), Arizona Health Sciences Center, Tucson; Department of Neurology, Hennepin County Medical Center, Minneapolis, Minn (Dr Anderson); Department of Medicine, Neurology Division, University of Texas Health Sciences Center, San Antonio (Dr Hart); and Statistics and Epidemiology Research Corp, Seattle, Wash (Ms Pearce).

Arch Intern Med. 1990;150(11):2340-2344. doi:10.1001/archinte.1990.00390220082016
Abstract

• We performed unenhanced computed tomographic scans on 141 asymptomatic patients with nonvalvular atrial fibrillation. Thirty-six patients (26%) had hypodense areas consistent with cerebral infarction. The majority of these were small deep infarcts, seen in 29 patients (21%), but 13 patients (9%) had cortical or large deep infarctions. Twelve patients had more than one infarct on computed tomographic scan. Increasing age and increased left atrial diameter were the only clinical features associated with asymptomatic infarction. Patients older than 65 years with a left atrial diameter greater than 5.0 cm (n = 23) had a 52% prevalence of asymptomatic infarction. Patients younger than 65 years with a left atrial diameter less than 5.0 cm (n = 38) had an 11% prevalence of silent infarction. Patients with only one of these risk factors (n = 72) had a 24% prevalence of silent infarction. Infarction was more common in those with chronic (34%) as opposed to intermittent (22%) nonvalvular atrial fibrillation, but this difference was not significant. Hypertension, diabetes, duration of atrial fibrillation, congestive heart failure, history of myocardial infarction, and echocardiographic evidence of left ventricular dysfunction were not associated with asymptomatic infarction. A history of hypertension was present in only 35% of our patients with small-deep asymptomatic infarction, similar to the percentage in patients without stroke. Asymptomatic cerebral infarction is common in nonvalvular atrial fibrillation. The association with enlarged left atria and the lack of correlation with major cerebrovascular risk factors suggests a cardioembolic mechanism. Further study is needed to determine the functional and prognostic significance of these strokes.

(Arch Intern Med. 1990;150:2340-2344)

×