CO071 | ATRIAL FIBRILLATION, CEREBRAL SMALL VESSEL DISEASE, AND GENDER MEDICINE: FOCUS ON BIOMARKERS AND NEUROIMAGING
Abstract
Background. Atrial fibrillation (AF) is the most common supraventricular arrythmia and one of the most commonly encountered heart conditions in clinical practice. Emerging evidence suggests a significant role of inflammation, endothelial dysfunction, and extracellular matrix (ECM) remodeling in the pathogenesis of AF. Population studies have also suggested an association between AF and cerebral small vessel disease (CSVD) with growing evidence indicating that the burden of certain markers of CSVD is greater in women. However, the association between female sex and CSVD remains poorly understood. Objectives. The main outcome of the study was thus to investigate the role of gender in the association between circulating biomarkers and the progression of CSVD in AF patients undergoing oral anticoagulant therapy. Methods. The Strat-AF study is an observational, prospective, single-center, hospital-based study enrolling elderly patients with AF. Results refer to 170 patients (60 women and 110 men). Recruited patients are evaluated by means of a comprehensive protocol, with clinical, cerebral magnetic resonance imaging (MRI), and circulating biomarker assessment. Results. At multivariate logistic regression analysis adjusted for age, CHA2DS2-VASc HAS-BLED and type of anticoagulant, independent predictors were: high levels of vWF for the presence of lacunar infarcts in women [OR 95% CI 3,24 (1,23-8,55), p=0.018]; high levels of TIMP-1 for having at least one sign of SVD at the SVD score in men [OR 95% CI 7,25 (2.18-24.15), p=0.001]; high levels of MMP-12, TIMP-1, TIMP-2 and TIMP-4 for the presence of CMB in women [OR 95% CI 7,76 (1,60-37,69), p=0,021; OR 95% CI 1,90 (1,02-3,52), p=0,042; OR 95% CI 2,46 (1,27 4,80), p=0,008 e OR 95% CI 2,36 (1,12-4,95), p=0,023, rispectively]; high levels of TIMP-1 for the presence of bgEPVS in men [OR 95% CI 2,20 (1,11-4,38), p=0,025] and high levels of MMP-12 and TIMP-2 for the presence of bgEPVS in women [OR 95% CI 2,57 (1,22-5,93), p=0,027 and OR 95% CI 2,15 (1,03-4,53), p=0,043, respectively]; elevated IL-6 and MMP-2, levels for the presence the presence of white matter hyperintensities in women [OR 10.65 (1.31–86.67), p = 0.027; OR 3.36 (1.23–9.15), p = 0.018, respectively]; elevated TIMP-1 levels for the presence the presence of white matter hyperintensities in men [OR 2.10 (1.08–4.08), p = 0.030]. Conclusions. These results from the Strat-AF study demonstrated that a complete biohumoral and instrumental assessment can jointly identify female patients with AF at higher risk of SVD. These findings pave the way for the implementation of clinical protocols incorporating brain MRI and circulating biomarkers as potential innovative tools for an increasingly refined—and sex-specific—stratification of cardiovascular risk in AF patients undergoing oral anticoagulant therapy.
Related
- Frontal Cerebral Blood Flow Deficits in Behavioral Variant Frontotemporal Dementia: Associations With Clinical Symptoms, Peripheral Vascular Biomarkers, and Neuroimaging Measures.
- Multimodal Characterization of APOE ε4-Associated Neurovascular Heterogeneity Using Retinal, Plasma, and Neuroimaging Biomarkers in Alzheimer's Disease.
- Atherosclerotic cardiovascular disease risk is associated with AT(N)V neuroimaging biomarkers and cognitive impairment in the health and aging brain study-health disparities cohort.
- Warfarin anticoagulation control and risks of cerebral small vessel disease and cognitive impairment among elderly patients with ischemic stroke and atrial fibrillation: a retrospective cohort study
- Preprocedural cerebral small vessel disease burden predicts one-year cognitive decline in patients with atrial fibrillation undergoing left atrial appendage occlusion: a prediction model and mediation analysis
BibTeX
@article{alfano2026co071,
title = {{CO071 | ATRIAL FIBRILLATION, CEREBRAL SMALL VESSEL DISEASE, AND GENDER MEDICINE: FOCUS ON BIOMARKERS AND NEUROIMAGING}},
author = {Francesco Alfano},
journal = {Bleeding, Thrombosis and Vascular Biology},
year = {2026},
month = oct,
url = {https://www.btvb.org/btvb/article/view/773},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - CO071 | ATRIAL FIBRILLATION, CEREBRAL SMALL VESSEL DISEASE, AND GENDER MEDICINE: FOCUS ON BIOMARKERS AND NEUROIMAGING
AU - Francesco Alfano
PY - 2026
DA - 2026/10/26
JO - Bleeding, Thrombosis and Vascular Biology
UR - https://www.btvb.org/btvb/article/view/773
AB - Background. Atrial fibrillation (AF) is the most common supraventricular arrythmia and one of the most commonly encountered heart conditions in clinical practice. Emerging evidence suggests a significant role of inflammation, endothelial dysfunction, and extracellular matrix (ECM) remodeling in the pathogenesis of AF. Population studies have also suggested an association between AF and cerebral small vessel disease (CSVD) with growing evidence indicating that the burden of certain markers of CSVD is greater in women. However, the association between female sex and CSVD remains poorly understood. Objectives. The main outcome of the study was thus to investigate the role of gender in the association between circulating biomarkers and the progression of CSVD in AF patients undergoing oral anticoagulant therapy. Methods. The Strat-AF study is an observational, prospective, single-center, hospital-based study enrolling elderly patients with AF. Results refer to 170 patients (60 women and 110 men). Recruited patients are evaluated by means of a comprehensive protocol, with clinical, cerebral magnetic resonance imaging (MRI), and circulating biomarker assessment. Results. At multivariate logistic regression analysis adjusted for age, CHA2DS2-VASc HAS-BLED and type of anticoagulant, independent predictors were: high levels of vWF for the presence of lacunar infarcts in women [OR 95% CI 3,24 (1,23-8,55), p=0.018]; high levels of TIMP-1 for having at least one sign of SVD at the SVD score in men [OR 95% CI 7,25 (2.18-24.15), p=0.001]; high levels of MMP-12, TIMP-1, TIMP-2 and TIMP-4 for the presence of CMB in women [OR 95% CI 7,76 (1,60-37,69), p=0,021; OR 95% CI 1,90 (1,02-3,52), p=0,042; OR 95% CI 2,46 (1,27 4,80), p=0,008 e OR 95% CI 2,36 (1,12-4,95), p=0,023, rispectively]; high levels of TIMP-1 for the presence of bgEPVS in men [OR 95% CI 2,20 (1,11-4,38), p=0,025] and high levels of MMP-12 and TIMP-2 for the presence of bgEPVS in women [OR 95% CI 2,57 (1,22-5,93), p=0,027 and OR 95% CI 2,15 (1,03-4,53), p=0,043, respectively]; elevated IL-6 and MMP-2, levels for the presence the presence of white matter hyperintensities in women [OR 10.65 (1.31–86.67), p = 0.027; OR 3.36 (1.23–9.15), p = 0.018, respectively]; elevated TIMP-1 levels for the presence the presence of white matter hyperintensities in men [OR 2.10 (1.08–4.08), p = 0.030]. Conclusions. These results from the Strat-AF study demonstrated that a complete biohumoral and instrumental assessment can jointly identify female patients with AF at higher risk of SVD. These findings pave the way for the implementation of clinical protocols incorporating brain MRI and circulating biomarkers as potential innovative tools for an increasingly refined—and sex-specific—stratification of cardiovascular risk in AF patients undergoing oral anticoagulant therapy.
SN - 2785-5309
ER -