Biomarker, Imaging, and Clinical Factors Associated With Overt and Covert Stroke in Patients With Atrial Fibrillation.
| Autor: | De Marchis GM; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.).; Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland.; Department of Neurology and Stroke Center, Kantonsspital St.Gallen, Switzerland (G.M.D.M., T.D.D.)., Krisai P; Cardiology Division, Department of Medicine, University Hospital Basel, Switzerland (P.K., M.C., S.O., M.K.)., Werlen L; Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland., Sinnecker T; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.).; Department of Biomedical Engineering, Medical Image Analysis Center AG and Qbig (T.S., J.W.), University of Basel, Switzerland., Aeschbacher S; Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland., Dittrich TD; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.).; Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland.; Department of Neurology and Stroke Center, Kantonsspital St.Gallen, Switzerland (G.M.D.M., T.D.D.)., Polymeris AA; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.)., Coslovksy M; Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland.; Cardiology Division, Department of Medicine, University Hospital Basel, Switzerland (P.K., M.C., S.O., M.K.)., Blum MR; Institute of Primary Health Care (BIHAM) (M.R.B., N.R.), University of Bern, Switzerland.; Department of General Internal Medicine, Inselspital, Bern University Hospital (M.R.B., N.R.), University of Bern, Switzerland., Rodondi N; Institute of Primary Health Care (BIHAM) (M.R.B., N.R.), University of Bern, Switzerland.; Department of General Internal Medicine, Inselspital, Bern University Hospital (M.R.B., N.R.), University of Bern, Switzerland., Reichlin T; Department of Cardiology, Inselspital, Bern University Hospital (T.R.), University of Bern, Switzerland., Moschovitis G; Cardiology Division, Ente Ospedaliero Cantonale, Istituto Cardiocentro Ticino, Regional Hospital of Lugano, Switzerland (G.M.)., Wuerfel J; Department of Biomedical Engineering, Medical Image Analysis Center AG and Qbig (T.S., J.W.), University of Basel, Switzerland., Lyrer PA; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.).; Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland., Fischer U; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.).; Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland.; Department of Neurology, University Hospital Bern, Switzerland (U.F.)., Conen D; Population Health Research Institute, McMaster University, Hamilton, Canada (D.C.)., Kastner P; Roche Diagnostics GmbH, Penzberg, Germany (P.K., A.Z.)., Ziegler A; Roche Diagnostics GmbH, Penzberg, Germany (P.K., A.Z.)., Osswald S; Cardiology Division, Department of Medicine, University Hospital Basel, Switzerland (P.K., M.C., S.O., M.K.)., Kühne M; Cardiovascular Research Institute Basel, Switzerland (P.K., S.A., S.O., M.K.)., Bonati LH; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.).; Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland.; Rheinfelden Rehabilitation Clinic, Switzerland (L.H.B.). |
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| Jazyk: | angličtina |
| Zdroj: | Stroke [Stroke] 2023 Oct; Vol. 54 (10), pp. 2542-2551. Date of Electronic Publication: 2023 Aug 07. |
| DOI: | 10.1161/STROKEAHA.123.043302 |
| Abstrakt: | Background: Atrial fibrillation is a major risk factor for stroke and silent brain infarcts. We studied whether a multimodal approach offers additional insights to the CHA Methods: Swiss-AF is a prospective, multicenter cohort study of patients with known atrial fibrillation. We included patients with available brain MRI both at enrollment and 2 years later. The dates of the baseline and follow-up visits ranged from March 2014 to November 2020. The primary outcome was assessed 2 years after baseline and was defined as a composite of clinically identified stroke or any new brain infarct on the 2-year MRI. We compared a multivariable logistic regression model including prespecified clinical, biomarker, and baseline MRI variables to the CHA Results: We included 1232 patients, 89.8% of them taking oral anticoagulants. The primary outcome occurred in 78 patients (6.3%). The following baseline variables were included in the final multivariate model and were significantly associated with the primary outcome: white matter lesion volume in milliliters (adjusted odds ratio [aOR], 1.91 [95% CI, 1.45-2.56]), NT-proBNP (N-terminal pro-B-type natriuretic peptide; aOR, 1.75 [95% CI, 1.20-2.63]), GDF-15 (growth differentiation factor-15; aOR, 1.68 [95% CI, 1.11-2.53]), serum creatinine (aOR, 1.50 [95% CI, 1.02-2.22]), IL (interleukin)-6 (aOR, 1.37 [95% CI, 1.00-1.86]), and hFABP (heart-type fatty acid-binding protein; aOR, 0.48 [95% CI, 0.31-0.73]). Overall performance and discrimination of the new model was superior to that of the CHA Conclusions: In patients with atrial fibrillation, a model incorporating white matter lesion volume on baseline MRI and selected blood markers yielded new insights on residual stroke risk despite a high proportion of patients on oral anticoagulants. This may be relevant to develop further preventive measures. Competing Interests: Disclosures Dr De Marchis reports honoraria by Bayer, Pfizer, Medtronic and a Grant from Novartis unrelated to the present work. Industry payments are made to the research fund of the University Hospital Basel. Dr Aeschbacher reports speaker fees from Roche Diagnostics. Dr Reichlin reports consultant honoraria/grants from Abbott Laboratories, Biosense Webster, Inc, Biotronik, Boston Scientific Corporation, and Medtronic. Dr Moschovitis has received consultant fees for taking part to advisory boards from Novartis, Boehringer Ingelheim, Bayer, Astra Zeneca and Daiichi Sankyo, all outside of the submitted work. Dr Wuerfel is employed at Roche. Dr Lyrer reports honoraria from Bayer, Biogen, Boehringer Ingelheim, Pfizer – all unrelated to the present work – and grants from the Swiss National Science Foundation and University Hospital Basel (intramural grant). Dr Fischer reports grant/contracts from Alexion, Biogen, Medtronic Vascular, Penumbra, Phenox, Rapid Medical, as well as support from Stryker and CSL Behring Foundation for Research and Advancement of Patient Health. Dr Conen reports consultation fees from Roche Diagnostics and Trimedics, as well as speaker fees from Servier and Pfizer. Dr Ziegler is employed at Roche Diagnostics International. Dr Kühne reports personal fees from Bayer, personal fees from Böhringer Ingelheim, personal fees from Pfizer Bristol-Myers Squibb (BMS), personal fees from Daiichi Sankyo, personal fees from Medtronic, personal fees from Biotronik, personal fees from Boston Scientific, personal fees from Johnson&Johnson, personal fees from Roche, grants from Bayer, grants from Pfizer, grants from Boston Scientific, grants from BMS, grants from Biotronik, grants from Daiichi Sankyo. Dr Bonati reports honoraria from Amgen, AstraZeneca, Bayer, BMS, Claret Medical, grants from the Swiss National Science Foundation, Swiss Heart Foundation, University of Basel, and Stiftung zur Förderung der gastroenterologischen und allgemeinen klinischen Forschung sowie der medizinischen Bildauswertung. The other authors report no conflicts. |
| Databáze: | MEDLINE |
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