Biomarkers Predictive of Atrial Fibrillation in Patients with Cryptogenic Stroke. Insights from The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study
(2023) In European Journal of Neurology 30(5). p.1352-1363- Abstract
BACKGROUND: There are currently no biomarkers used to select cryptogenic stroke (CS) patients for monitoring with insertable cardiac monitors (ICMs), the most effective tool for diagnosing atrial fibrillation (AF) in CS. The purpose of this study was to assess clinically available biomarkers as predictors of AF.
METHODS: Eligible CS and cryptogenic transient ischemic attack (TIA) 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 (ROC) curves were created.... (More)
BACKGROUND: There are currently no biomarkers used to select cryptogenic stroke (CS) patients for monitoring with insertable cardiac monitors (ICMs), the most effective tool for diagnosing atrial fibrillation (AF) in CS. The purpose of this study was to assess clinically available biomarkers as predictors of AF.
METHODS: Eligible CS and cryptogenic transient ischemic attack (TIA) 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 (ROC) curves were created. Biomarkers reaching area under ROC curve (AUC) ≥ 0.7 were dichotomized by finding optimal cut-off values and 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, high-sensitivity cardiac Troponin I and T were significantly higher in the AF than non-AF group. BNP and NT-proBNP reached predefined AUC 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 (OR) 7.72 (95% confidence interval [CI] 3.16-18.87), and age and sex adjusted models, OR 4.82 (95% CI 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.
(Less)
- author
- author collaboration
- organization
- publishing date
- 2023-02-14
- type
- Contribution to journal
- publication status
- published
- subject
- in
- European Journal of Neurology
- volume
- 30
- issue
- 5
- pages
- 1352 - 1363
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:36786305
- scopus:85150646998
- ISSN
- 1351-5101
- DOI
- 10.1111/ene.15746
- language
- English
- LU publication?
- yes
- additional info
- This article is protected by copyright. All rights reserved.
- id
- fc869f0a-6acb-4f99-bb03-d131cd3fa844
- date added to LUP
- 2023-02-26 17:14:52
- date last changed
- 2024-06-14 23:36:31
@article{fc869f0a-6acb-4f99-bb03-d131cd3fa844,
abstract = {{<p>BACKGROUND: There are currently no biomarkers used to select cryptogenic stroke (CS) patients for monitoring with insertable cardiac monitors (ICMs), the most effective tool for diagnosing atrial fibrillation (AF) in CS. The purpose of this study was to assess clinically available biomarkers as predictors of AF.</p><p>METHODS: Eligible CS and cryptogenic transient ischemic attack (TIA) 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 (ROC) curves were created. Biomarkers reaching area under ROC curve (AUC) ≥ 0.7 were dichotomized by finding optimal cut-off values and used in logistic regression establishing their predictive value for increased risk of AF in unadjusted and adjusted models.</p><p>RESULTS: B-type natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase, D-dimer, high-sensitivity cardiac Troponin I and T were significantly higher in the AF than non-AF group. BNP and NT-proBNP reached predefined AUC 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 (OR) 7.72 (95% confidence interval [CI] 3.16-18.87), and age and sex adjusted models, OR 4.82 (95% CI 1.79-12.96).</p><p>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.</p>}},
author = {{Tancin Lambert, Anna and Ratajczak-Tretel, Barbara and Al-Ani, Riadh and Arntzen, Kathrine and Bakkejord, Grete Kristin and Bekkeseth, Hanna Marie Otterholt and Bjerkeli, Vigdis and Eldøen, Guttorm and Gulsvik, Anne Kristine and Halvorsen, Bente and Høie, Gudrun Anette and Ihle-Hansen, Hege and Ihle-Hansen, Håkon and Ingebrigtsen, Susanne and Johansen, Henriette and Kremer, Christine and Krogseth, Siv Bohne and Kruuse, Christina and Kurz, Martin and Nakstad, Ingvild and Novotny, Vojtech and Naess, Halvor and Qazi, Rehman and Rezai, Mehdi Kallaj and Rørholt, Dag Marius and Steffensen, Linn Hofsoy and Sømark, Jesper and Tobro, Håkon and Truelsen, Thomas Clement and Wassvik, Lejla and AEgidius, Karen Lehrmann and Pesonen, Maiju and de Melis, Mirko and Atar, Dan and Aamodt, Anne Hege}},
issn = {{1351-5101}},
language = {{eng}},
month = {{02}},
number = {{5}},
pages = {{1352--1363}},
publisher = {{Wiley-Blackwell}},
series = {{European Journal of Neurology}},
title = {{Biomarkers Predictive of Atrial Fibrillation in Patients with Cryptogenic Stroke. Insights from The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study}},
url = {{http://dx.doi.org/10.1111/ene.15746}},
doi = {{10.1111/ene.15746}},
volume = {{30}},
year = {{2023}},
}