The association of Atrial Fibrillation and Renal Biomarkers with Brain MRI Abnormalities: An investigation using Systolic Blood Pressure Intervention Trial (SPRINT) research materials Open Access

Soyebo, Britt (Spring 2022)

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Objective & Background 

The increased risk of dementia and cognitive impairment associated with atrial fibrillation (AF), independent of stroke, suggests additional effects of AF on the brain. Due to the paucity of research investigating AF and brain morphology, this study seeks to examine (1) the impact of AF and renal dysfunction on brain structure and morphology and (2) evaluate the synergistic effect between AF and biomarkers of renal dysfunction on brain volumetric measures.



Data were obtained from the SPRINT (Systolic Blood Pressure Intervention Trial), a single-blind randomized clinical trial designed to test a lower systolic blood pressure (SBP) target to prevent cardiovascular disease in persons with elevated cardiovascular risk but without diabetes or stroke. In 2010–2012 participants completed questionnaires, a clinical exam and provided blood and urine samples. This cross-sectional analysis evaluated a subset of participants who underwent brain magnetic resonance imaging at baseline.  Variables of interest included lobar brain volumes, cerebral blood flow and markers of white matter disease. AF diagnoses were based on self-report and scheduled ECG. Serum creatinine was used to obtain estimated glomerular filtration rate (eGFRF) and albumin creatine ratio was measure in urine samples.



We studied 625 (mean age=67±8.1 years; 60% men) individuals; 41 (6.5 %) participants had prevalent AF at the time of MRI. Mild eGFRF and high albuminuria categories were associated with prevalent AF (OR= 3.45; 95% CI: 1.06, 11.21). In multivariate analysis, AF was associated with reduced entorhinal cortex volume (-0.12 mm3; 95% CI -0.22, -0.02) and posterior cingulate gyrus volume (-5.63 mm3; 95% CI -10.9, -0.35) and lower frontal cerebral blood flow (-3.4 mL/min, 95% CI -6.69, -0.07). No significant effect modification by CKD was observed in the associations between AF and brain imaging characteristics.



AF is associated with smaller brain volumes in selected areas. The association was not modified by lower renal function. These findings suggest that AF has a cumulative negative effect on the brain independent of stroke. 


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