Biomarkers predictive of atrial fibrillation in patients with cryptogenic stroke. Insights from the Nordic Atrial Fibrillation and Stroke (NOR-FIB) study.

Autor: Tancin Lambert A; Department of Neurology, Østfold Hospital Trust, Grålum, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Ratajczak-Tretel B; Department of Neurology, Østfold Hospital Trust, Grålum, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Al-Ani R; Department of Cardiology, Østfold Hospital Trust, Grålum, Norway., Arntzen K; Department for Neurology, Nordlandssykehuset, Bodø, Norway., Bakkejord GK; Department for Neurology, Nordlandssykehuset, Bodø, Norway., Bekkeseth HMO; Department of Neurology, Innlandet Hospital Trust, Lillehammer Hospital, Lillehammer, Norway., Bjerkeli V; Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway., Eldøen G; Department of Neurology, Molde Hospital, Molde, Norway., Gulsvik AK; Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway., Halvorsen B; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway., Høie GA; Department of Cardiology, Østfold Hospital Trust, Grålum, Norway., Ihle-Hansen H; Department of Neurology, Stroke Unit, Oslo University Hospital, Ullevål, Oslo, Norway., Ihle-Hansen H; Department of Internal Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Gjettum, Norway., Ingebrigtsen S; Department of Neurology, University Hospital of North Norway, Tromsø, Norway., Johansen H; Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Kremer C; Department of Neurology, Skåne University Hospital, Malmö, Sweden.; Department of Clinical Sciences, Lund University, Malmö, Sweden., Krogseth SB; Department of Neurology, Vestfold Hospital, Tønsberg, Norway., Kruuse C; Department of Neurology, Herlev Gentofte Hospital, Herlev, Denmark., Kurz M; Department of Neurology, Stavanger University Hospital, Stavanger, Norway., Nakstad I; Department of Neurology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway., Novotny V; Department of Neurology, Haukeland University Hospital, Bergen, Norway., Naess H; Department of Neurology, Haukeland University Hospital, Bergen, Norway., Qazi R; Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway., Rezai MK; Department of Neurology, Stavanger University Hospital, Stavanger, Norway., Rørholt DM; Department of Neurology, Molde Hospital, Molde, Norway., Steffensen LH; Department of Neurology, University Hospital of North Norway, Tromsø, Norway., Sømark J; Department of Neurology, Innlandet Hospital Trust, Lillehammer Hospital, Lillehammer, Norway.; Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Tobro H; Department of Neurology, Telemark Hospital, Skien, Norway., Truelsen TC; Department of Neurology, Rigshospitalet University Hospital, Copenhagen, Denmark., Wassvik L; Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark., AEgidius KL; Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark., Pesonen M; Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway., de Melis M; Bakken Research Center, Maastricht, The Netherlands., Atar D; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway., Aamodt AH; Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Jazyk: angličtina
Zdroj: European journal of neurology [Eur J Neurol] 2023 May; Vol. 30 (5), pp. 1352-1363. Date of Electronic Publication: 2023 Mar 10.
DOI: 10.1111/ene.15746
Abstrakt: Background and Purpose: There are currently no biomarkers 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 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.
(© 2023 European Academy of Neurology.)
Databáze: MEDLINE
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