Biomarkers predictive of atrial fibrillation in patients with cryptogenic stroke. Insights from the Nordic Atrial Fibrillation and Stroke (NOR-FIB) study.
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Tancin Lambert Anna, Ratajczak-Tretel Barbara, Al-Ani Riadh, Arntzen Kathrine, Bakkejord Grete Kristin, Bekkeseth Hanna Marie Otterholt, Bjerkeli Vigdis, Eldøen Guttorm, Gulsvik Anne Kristine, Halvorsen Bente, Høie Gudrun Anette, Ihle-Hansen Hege, Ihle-Hansen Håkon, Ingebrigtsen Susanne, Johansen Henriette, Kremer Christine, Krogseth Siv Bohne, Kruuse Christina, Kurz Martin, Nakstad Ingvild, Novotny Vojtech, Naess Halvor, Qazi Rehman, Rezai Mehdi Kallaj, Rørholt Dag Marius, Steffensen Linn Hofsøy, Sømark Jesper, Tobro Håkon, Truelsen Thomas Clement, Wassvik Lejla, AEgidius Karen Lehrmann, Pesonen Maiju, de Melis Mirko, Atar Dan, Aamodt Anne Hege, NOR-FIB Study Group
Аннотация
METHODS: Eligible CS and cryptogenic transient ischaemic attack patients underwent 12-month monitoring with ICMs, clinical follow-up and biomarker sampling. Levels of cardiac and thromboembolic biomarkers, taken within 14 days from symptom onset, were compared between patients diagnosed with AF (n = 74) during monitoring and those without AF (n = 185). Receiver operating characteristic curves were created. Biomarkers reaching area under the receiver operating characteristic curve ≥ 0.7 were dichotomized by finding optimal cut-off values and were used in logistic regression establishing their predictive value for increased risk of AF in unadjusted and adjusted models.
RESULTS: B-type natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase, D-dimer and high-sensitivity cardiac troponin I and T were significantly higher in the AF than non-AF group. BNP and NT-proBNP reached the predefined area under the curve level, 0.755 and 0.725 respectively. Optimal cut-off values were 33.5 ng/l for BNP and 87 ng/l for NT-proBNP. Regression analysis showed that NT-proBNP was a predictor of AF in both unadjusted (odds ratio 7.72, 95% confidence interval 3.16-18.87) and age- and sex-adjusted models (odds ratio 4.82, 95% confidence interval 1.79-12.96).
CONCLUSION: Several clinically established biomarkers were associated with AF. NT-proBNP performed best as AF predictor and could be used for selecting patients for long-term monitoring with ICMs.