Blood-biomarkers and devices for atrial fibrillation screening: Lessons learned from the AFRICAT (Atrial Fibrillation Research In CATalonia) study.

Autor: Palà E; Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR)-Universitat Autónoma de Barcelona, Barcelona, Spain., Bustamante A; Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR)-Universitat Autónoma de Barcelona, Barcelona, Spain.; Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain., Clúa-Espuny JL; Equip d'Atenció Primària Tortosa Est, SAP Terres de l'Ebre, Institut Català de la Salut, Tortosa, Spain.; Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Unitat de Suport a la Recerca de Barcelona, Barcelona, Spain., Acosta J; Department of cardiology, Hospital Universitario Virgen del Rocio, Sevilla, Spain., González-Loyola F; Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Unitat de Suport a la Recerca de Barcelona, Barcelona, Spain.; Gerència Atenció Primària de Barcelona, Institut Català de la Salut, Barcelona, Spain., Santos SD; CAP Horta 7F, Àmbit d'Atenció Primària Barcelona ciutat, Institut Català de la Salut, Barcelona, Spain., Ribas-Segui D; EAP Sant Pere i Sant Pau, Institut Català de la Salut, Tarragona, Spain., Ballesta-Ors J; Equip d'Atenció Primària Tortosa Est, SAP Terres de l'Ebre, Institut Català de la Salut, Tortosa, Spain.; Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Unitat de Suport a la Recerca de Barcelona, Barcelona, Spain., Penalba A; Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR)-Universitat Autónoma de Barcelona, Barcelona, Spain., Giralt M; Biochemical department, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Lechuga-Duran I; Servicio Cardiología, Hospital Virgen De La Cinta, Institut Català Salut Tortosa, Tarragona, Spain., Gentille-Lorente D; Servicio Cardiología, Hospital Virgen De La Cinta, Institut Català Salut Tortosa, Tarragona, Spain., Pedrote A; Department of cardiology, Hospital Universitario Virgen del Rocio, Sevilla, Spain., Muñoz MÁ; Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Unitat de Suport a la Recerca de Barcelona, Barcelona, Spain.; Gerència Atenció Primària de Barcelona, Institut Català de la Salut, Barcelona, Spain., Montaner J; Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR)-Universitat Autónoma de Barcelona, Barcelona, Spain.; Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville & Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 Aug 23; Vol. 17 (8), pp. e0273571. Date of Electronic Publication: 2022 Aug 23 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0273571
Abstrakt: Background and Objective: AFRICAT is a prospective cohort study intending to develop an atrial fibrillation (AF) screening program through the combination of blood markers, rhythm detection devices, and long-term monitoring in our community. In particular, we aimed to validate the use of NT-proBNP, and identify new blood biomarkers associated with AF. Also, we aimed to compare AF detection using various wearables and long-term Holter monitoring.
Methods: 359 subjects aged 65-75 years with hypertension and diabetes were included in two phases: Phase I (n = 100) and Phase II (n = 259). AF diagnosis was performed by baseline 12-lead ECG, 4 weeks of Holter monitoring (NuuboTM), and/or medical history. An aptamer array including 1310 proteins was measured in the blood of 26 patients. Candidates were selected according to p-value, logFC and biological function to be tested in verification and validation phases. Several screening devices were tested and compared: AliveCor, Watch BP, MyDiagnostick and Fibricheck.
Results: AF was present in 34 subjects (9.47%). The aptamer array revealed 41 proteins with differential expression in AF individuals. TIMP-2 and ST-2 were the most promising candidates in the verification analysis, but none of them was further validated. NT-proBNP (log-transformed) (OR = 1.934; p<0.001) was the only independent biomarker to detect AF in the whole cohort. Compared to an ECG, WatchBP had the highest sensitivity (84.6%) and AUC (0.895 [0.780-1]), while MyDiagnostick showed the highest specificity (97.10%).
Conclusion: The inclusion and monitoring of a cohort of primary care patients for AF detection, together with the testing of biomarkers and screening devices provided useful lessons about AF screening in our community. An AF screening strategy using rhythm detection devices and short monitoring periods among high-risk patients with high NT-proBNP levels could be feasible.
Competing Interests: JM, AB, and EP had a patent filled with some of the results of this study (EP19382321.8). Other authors declare no conflicts of interest.
Databáze: MEDLINE
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