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Research paper
Atrial fibrillation is associated with anterior predominant white matter lesions in patients presenting with embolic stroke
  1. Yunis Mayasi1,
  2. Johanna Helenius2,
  3. David D McManus3,
  4. Richard P Goddeau Jr1,
  5. Adalia H Jun-O’Connell1,
  6. Majaz Moonis1,
  7. Nils Henninger1,4
  1. 1 Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  2. 2 Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  4. 4 Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  1. Correspondence to Dr Nils Henninger, Departments of Neurology and Psychiatry, University of Massachusetts Medical School, North Worcester, MA 01655, USA; nils.henninger{at}


Objective High white matter hyperintensity (WMH) burden is commonly found on brain MRI among patients with atrial fibrillation (AF). However, whether the link between AF and WMH extends beyond a common vascular risk factor profile is uncertain. We sought to determine whether AF relates to a distinct WMH lesion pattern which may suggest specific underlying pathophysiological relationships.

Methods We retrospectively analysed a cohort of consecutive patients presenting with embolic stroke at an academic hospital and tertiary referral centre between March 2010 and March 2014. In total, 234 patients (53% female, 74% anterior circulation infarction) fulfilled the inclusion criteria and were included in the analyses. WMH lesion distribution was classified according to previously defined categories. Multivariable logistic regression analysis was performed to determine variables associated with AF within 90 days of index hospital discharge.

Results Among included patients, 114 had AF (49%). After adjustment for the CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, prior stroke/TIA (doubled), vascular disease, age 65–74 years, sex category (female)) score, WMH lesion burden as assessed on the Fazekas scale, embolic stroke pattern, infarct distribution and pertinent interaction terms, AF was significantly associated with presence of anterior subcortical WMH patches (OR 3.647, 95% CI 1.681 to 7.911, p=0.001).

Conclusions AF is associated with specific WMH lesion pattern among patients with embolic stroke aetiology. This suggests that the link between AF and brain injury extends beyond thromboembolic complications to include a cardiovasculopathy that affects the brain and can be detected and characterised by WMH.

  • atrial fibrillation
  • cardioembolism
  • cerebral infarction
  • leukoaraiosis
  • small vessel disease
  • topography
  • white matter

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  • Contributors YM and NH were involved in drafting the manuscript and analysis and interpretation of the data. All authors revised the manuscript for important intellectual content. YM and NH were involved in study concept and design. YM, JH and NH were involved in acquisition of the data. NH was involved in statistical analysis. NH was involved in study supervision and coordination.

  • Funding NH is supported by K08NS091499 from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health. McM was supported by 1R01HL126911-01A1 and KL2RR031981 from the National Heart Lung and Blood Institute and the National Institutes of Health.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests NH serves on the advisory board of Omniox.

  • Ethics approval Local IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Deidentified aggregate patient and imaging data will be made available to researchers upon request.

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