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  • Review Article
  • Published:

Silent cerebral infarcts associated with cardiac disease and procedures

Nature Reviews Cardiology volume 10, pages 696–706 (2013)Cite this article

Subjects

Key Points

  • Silent cerebral infarcts (SCIs) are increasingly observed in patients with cardiac disease and in individuals who have undergone invasive cardiac procedures

  • Cardiac diseases associated with the occurrence of SCIs include atrial fibrillation, cardiomyopathies, and atrial septal abnormalities

  • Postprocedural SCIs have been detected using MRI after left cardiac catheterization, transcatheter aortic valve implantation, CABG surgery, pulmonary vein isolation, and closure of patent foramen ovale

  • SCIs do not always result in acute symptoms, but have been associated with a threefold increase in the risk of stroke, and can be considered a precursor of ischaemic stroke

  • Accumulating evidence suggests that SCIs might have a role in the development of dementia and depression, and in cognitive decline

  • Increased recognition of SCIs could advance our understanding of their links to cardiac and neurological disorders, and facilitate the development of preventative therapeutic approaches

Abstract

The occurrence of clinically silent cerebral infarcts (SCIs) in individuals affected by cardiac disease and after invasive cardiac procedures is frequently reported. Indeed, atrial fibrillation, left ventricular thrombus formation, cardiomyopathy, and patent foramen ovale have all been associated with SCIs. Furthermore, postprocedural SCIs have been observed after left cardiac catheterization, transcatheter aortic valve implantation, CABG surgery, pulmonary vein isolation, and closure of patent foramen ovale. Such SCIs are often described as precursors to symptomatic stroke and are associated with cognitive decline, dementia, and depression. Increased recognition of SCIs might advance our understanding of their relationship with heart disease and invasive cardiac procedures, facilitate further improvement of therapies or techniques aimed at preventing their occurrence and, therefore, decrease the risk of adverse neurological outcomes. In this Review, we provide an overview of the occurrence and clinical significance of, and the available diagnostic modalities for, SCIs related to cardiac disease and associated invasive cardiac procedures.

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Figure 1: Summary of cardioembolic heart diseases and cardiac procedures that have been associated with silent cerebral infarcts.
Figure 2: Schematic overview of silent to clinically apparent cerebral infarcts.

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Acknowledgements

This work was supported by grants from the Dutch Heart Foundation (2011 T022) and National Health Insurance Board/ZonMw, Netherlands (40-00703-98-11629) to R. Delewi.

Author information

Authors and Affiliations

  1. Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands

    Mariëlla E. C. Hassell, Jan J. Piek & Ronak Delewi

  2. Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands

    Yvo B. W. Roos

  3. Department of Neuroradiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands

    Charles B. L. Majoie

  4. Department of Cardiology, VU University Medical Center Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, Netherlands

    Robin Nijveldt

  5. Clinical Research Department, University Hospital of Caen, Avenue Côte de Nacre, Caen, Normandy, France

    Martial Hamon

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  1. Mariëlla E. C. Hassell
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  2. Robin Nijveldt
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  3. Yvo B. W. Roos
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  4. Charles B. L. Majoie
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  5. Martial Hamon
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  6. Jan J. Piek
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  7. Ronak Delewi
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Contributions

M. E. C. Hassell researched the data for the article. M. E. C. Hassell, R. Delewi, and R. Nijveldt contributed substantially to discussion of the content. M. E. C. Hassell and R. Delewi contributed substantially to writing the article. All the authors reviewed/edited the manuscript before submission.

Corresponding author

Correspondence to Ronak Delewi.

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Competing interests

The authors declare no competing financial interests.

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Hassell, M., Nijveldt, R., Roos, Y. et al. Silent cerebral infarcts associated with cardiac disease and procedures. Nat Rev Cardiol 10, 696–706 (2013). https://doi.org/10.1038/nrcardio.2013.162

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