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Published on: July 20, 2022
Clinical Applications of Biomarkers in Atrial Fibrillation
Kay-Won Chang1, Jonathan C Hsu1, Avinash Toomu1
1Division of Cardiology, Department of Medicine, Veterans Affair San Diego Healthcare System, University of California, San Diego.
Insights
Biomarkers are increasingly important for managing atrial fibrillation, aiding in risk assessment and diagnosis. This review surveys current evidence and proposes algorithms for their clinical use.
Area of Science:
- Cardiology
- Biomarker Research
- Clinical Medicine
Background:
- Biomarker utilization has lagged in atrial fibrillation management compared to myocardial infarction and heart failure.
- European Society of Cardiology guidelines now recommend considering biomarkers like high-sensitivity troponin and natriuretic peptide for risk stratification in atrial fibrillation.
Purpose of the Study:
- To provide a comprehensive review of existing evidence on biomarker use in atrial fibrillation.
- To propose clinical algorithms to assist internists in integrating biomarkers into atrial fibrillation patient management.
Main Methods:
- Systematic review of current scientific literature on biomarkers in atrial fibrillation.
- Analysis of associations between biomarker levels and various atrial fibrillation contexts (incident, postoperative, acute, co-existing conditions, prognosis).
Main Results:
- Biomarker levels are linked to incident, postoperative, and acute atrial fibrillation.
- Biomarkers aid in diagnosing myocardial infarction and heart failure in atrial fibrillation patients.
- Biomarker levels correlate with prognosis in atrial fibrillation.
Conclusions:
- Biomarkers hold significant potential to enhance atrial fibrillation diagnosis and management.
- Further integration of biomarkers into clinical practice is warranted, supported by proposed management algorithms.
Abstract:
While biomarkers have greatly impacted the diagnosis and management of myocardial infarction and heart failure, the use of biomarkers has been slow to permeate management of atrial fibrillation. Guideline recommendations on the use of biomarkers in atrial fibrillation were virtually nonexistent until the 2016 European Society of Cardiology guidelines on atrial fibrillation offered a class IIb recommendation to consider using biomarkers such as high-sensitivity troponin and natriuretic peptide to further refine stroke and bleeding risk in atrial fibrillation patients. Biomarker levels have been associated with incident atrial fibrillation, postoperative atrial fibrillation, acute atrial fibrillation, diagnosis of myocardial infarction and heart failure in atrial fibrillation, and prognosis in atrial fibrillation. This review will offer an in-depth survey of current evidence on the use of biomarkers in atrial fibrillation and propose clinical algorithms to aid the internist in using biomarkers in atrial fibrillation management.
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