TY - JOUR

T1 - Biomarkers predictive of atrial fibrillation in patients with cryptogenic stroke. Insights from the Nordic Atrial Fibrillation and Stroke (NOR-FIB) study

AU - Tancin Lambert, Anna

AU - Ratajczak-Tretel, Barbara

AU - Al-Ani, Riadh

AU - Arntzen, Kathrine

AU - Bakkejord, Grete Kristin

AU - Bekkeseth, Hanna Marie Otterholt

AU - Bjerkeli, Vigdis

AU - Eldøen, Guttorm

AU - Gulsvik, Anne Kristine

AU - Halvorsen, Bente

AU - Høie, Gudrun Anette

AU - Ihle-Hansen, Hege

AU - Ihle-Hansen, Håkon

AU - Ingebrigtsen, Susanne

AU - Johansen, Henriette

AU - Kremer, Christine

AU - Krogseth, Siv Bohne

AU - Kruuse, Christina

AU - Kurz, Martin

AU - Nakstad, Ingvild

AU - Novotny, Vojtech

AU - Næss, Halvor

AU - Qazi, Rehman

AU - Rezai, Mehdi Kallaj

AU - Rørholt, Dag Marius

AU - Steffensen, Linn Hofsøy

AU - Sømark, Jesper

AU - Tobro, Håkon

AU - Truelsen, Thomas Clement

AU - Wassvik, Lejla

AU - Ægidius, Karen Lehrmann

AU - Pesonen, Maiju

AU - de Melis, Mirko

AU - Atar, Dan

AU - Aamodt, Anne Hege

AU - NOR-FIB study group

N1 - Publisher Copyright: © 2023 European Academy of Neurology.

PY - 2023

Y1 - 2023

N2 - 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.

AB - 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.

KW - atrial fibrillation

KW - biomarkers

KW - cardiac rhythm monitoring

KW - cryptogenic stroke

KW - insertable cardiac monitors

U2 - 10.1111/ene.15746

DO - 10.1111/ene.15746

M3 - Journal article

C2 - 36786305

AN - SCOPUS:85150646998

VL - 30

SP - 1352

EP - 1363

JO - European Journal of Neurology

JF - European Journal of Neurology

SN - 1351-5101

IS - 5

ER -