| Sažetak | Cilj istraživanja: svrha ovog istraživanja je bila utvrditi povezanost perzistentne fibrilacije
atrija (FA) s perfuzijom mozga, specifičnim neurološkim biomarkerima, morfološkom
analizom mozga i kognicijom u usporedbi s kontrolnom skupinom i u odnosu prema
električnoj kardioverziji (EKV).
Materijali i metode: u studiji je uspoređeno 25 bolesnika s perzistentnom FA predviđenih za
elektivnu EKV sa 16 dobno/spolno prilagođenih kontrolnih ispitanika bez anamneze FA.
Regionalna perfuzija mozga je mjerena je tehnikom označavanja arterijskog spina na
magnetskoj rezonanciji (MR). Između skupina su uspoređene razine glijalnog fibrilarnog
kiselog proteina (GFAP), serumskog neurofilamenta lakog lanca (sNfL) i ubikvitin karboksilterminalne hidrolaze L1 (UCH-L1) u serumu, kao i parametri morfološke analize mozga te
kognitivna funkcija. Mofološka analiza mozga je provedena standardnim MR protokolom.
Kognitivna funkcija je procijenjena korištenjem indeksa kognitivne funkcije informacijskog
sustava mjerenja ishodâ kojih prijavljuju bolesnici (PROMIS). Mjerenja su obavljena na
početku i 6 tjedana nakon EKV.
Rezultati: nije bilo značajne razlike u perfuziji mozga između bolesnikâ s FA i kontrolnih
ispitanika (p>0,05). Nakon EKV nastupilo je značajno poboljšanje perfuzije mozga u 15
bolesnika u kojih je održan sinusni ritam (297 ± 24 prije, naspram 328 ± 37 nakon EKV, p =
0,008), za razliku od bolesnika s povratom aritmije (297 ± 22 prije, naspram 307 ± 24 nakon
EKV, p=0,45). Značajne razlike nije bilo u vrijednosti GFAP-a (medijan 24,7 naspram 28,7
pg/ml, p=0,347), UCH-L1-a (medijan 112,8 naspram 117,7 pg/ml, p=0,885) i sNfL-a
(medijan 14,2 naspram 15,4 pg/ml, p=0,886) između bolesnika s FA i kontrolnih ispitanika.
Morfološka analiza također nije pokazala razlike između skupina u kortikalnim i velikom nekortikalnim lezijama (n=2, 8,0% naspram n=0, 0,0%, p=0,246), malim ne-kortikalnim
lezijama (n=5, 20,0% naspram n=5, 31,3%, p=0,413), hiperintenzitetima bijele tvari (n=23,
92,0% naspram n=14, 87,5%, p=0,636), dok je u kontrolnoj skupini bilo više moždanih
mikrokrvarenja (n=0, 0,0% naspram n=3, 18,8%, p=0,025). Kognitivna procjena nije
pokazala razlike između skupina u PROMIS indeksu (52,2 ± 9,6 naspram 51,2 ± 6,2,
p=0,706), kao ni u skupini bolesnika s FA prije i nakon EKV (52,7 ± 10,1 naspram 53,9 ± 9,
p=0,46). Konačno, nije bilo značajne dinamike u vrijednostima neuroloških biomarkera
(p>0,05) kao ni novih embolijskih lezija u mozgu nakon EKV.
Zaključci: Ovo istraživanje nije pronašlo razlike u perfuziji mozga između bolesnika s
perzistentnom FA i kontrolnih ispitanika sličnog kardiovaskularnog profila. Uspostava
sinusnog ritma je bila povezana sa značajnim poboljšanjem moždane perfuzije. Nadalje, istraživanje nije pokazalo značajne razlike u neurološkim biomarkerima, morfološkoj analizi
mozga ili kognitivnoj funkciji između skupina. Nije bilo povezanosti između EKV i promjena
u neurološkim biomarkerima ili kognitivnoj funkciji. |
| Sažetak (engleski) | Objectives: This study aimed to determine the association of persistent atrial fibrillation (AF)
with brain perfusion (BP), specific neurologic biomarkers, neuroimaging findings and
cognition, in comparison to control subjects and with regards to electrical cardioversion
(ECV).
Materials and methods: This study compared 25 patients with persistent AF undergoing
elective ECV with 16 age/sex-matched controls. Regional BP was measured by using the
magnetic resonance (MRI) arterial spin labelling technique. Plasma levels of glial fibrillary
acidic protein (GFAP), neurofilament light protein (sNfL) and ubiquitin carboxyl-terminal
hydrolase L1 (UCH-L1), as well as parameters of neuroimaging and cognitive function, were
compared between the groups. Neuroimaging was performed using the standard MRI
protocol. Cognitive function was assessed using the Patient-Reported Outcomes Measurement
Information System (PROMIS) cognitive function index. Measurements were performed at
baseline and 6 weeks after ECV.
Results: There was no significant difference in BP between AF patients and control subjects
(p>0.05). Following the ECV, there was a significant improvement in BP in 15 patients who
maintained sinus rhythm, while there was no significant change in the recurrence group (297
± 24 before vs. 328 ± 37 after ECV, p=0.008, and 297 ± 22 before vs. 307 ± 24 after ECV,
p=0.45, respectively). There was no significant difference in GFAP (median of 24.7 vs. 28.7
pg/mL, p=0.347), UCH-L1 (median of 112.8 vs. 117.7 pg/mL, p=0.885), and sNfL (median of
14.2 vs. 15.4 pg/mL, p=0.886) levels between AF patients and control subjects. Similarly,
neuroimaging showed no between-group difference in cortical and large non-cortical lesions
(n=2, 8.0% vs. n=0, 0.0%, p=0.246), small noncortical lesions (n=5, 20.0% vs. n=5, 31.3%,
p=0.413), white matter hyperintensity (n=23, 92.0% vs. n=14, 87.5%, p=0.636), while there
were more cerebral microbleeds in control group (n=0, 0.0% vs. n=3, 18.8%, p=0.025).
Cognitive assessment did not show any between-group difference in the PROMIS index (52.2
± 9.6 vs. 51.2 ± 6.2, p=0.706), as well as before and after ECV within the AF group (52.7 ±
10,1 vs. 53.9 ± 9, p=0.46). Finally, there were no significant dynamics in neurologic
biomarkers following electrical cardioversion (p>0.05) and no new embolic brain lesions.
Conclusions: This study did not show difference in BP between persistent AF patients and
matched control subjects. Restoration of sinus rhythm was associated with significantly
improved BP. Also, study did not find a significant difference in neurologic biomarkers, neuroimaging findings, or cognitive function between groups. There was no association of
ECV and changes in neurologic biomarkers or cognitive function. |
