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Updated: Feb 21, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Biomarkers of Atrial Fibrillation in Hypertension
Costas Tsioufis1, Dimitris Konstantinidis1, Ilias Nikolakopoulos1
1First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
Insights
Undiagnosed atrial fibrillation (AF) is common in hypertensive patients. Biomarkers for AF diagnosis and risk stratification, including electrophysiological, structural, and molecular markers, are crucial for early detection and management.
Area of Science:
- Cardiology
- Biomarker Discovery
- Hypertension Research
Background:
- Atrial fibrillation (AF) is a prevalent arrhythmia increasing thromboembolic risk.
- Hypertension exacerbates AF risk and cerebrovascular ischemia.
- Prompt diagnosis of undiagnosed AF in hypertensive individuals is critical.
Purpose of the Study:
- To review literature on biomarkers for AF diagnosis.
- To identify biomarkers predicting AF progression in hypertensive patients.
- To assess current diagnostic limitations and future directions.
Main Methods:
- Literature review focusing on AF diagnostic and prognostic biomarkers.
- Categorization of biomarkers into electrophysiological, morphological, and molecular types.
- Assessment of specific markers like P-wave duration, atrial size, and inflammatory/fibrotic markers.
Main Results:
- Electrophysiological markers include P-wave duration and dispersion.
- Structural markers involve left atrial size, fibrosis, hypertrophy, and aortic stiffness.
- Molecular markers encompass neurohormonal peptides (BNP, NT-proBNP), inflammatory cytokines (CRP, IL-6), and fibrosis indicators (TGF-β1).
Conclusions:
- Individual biomarkers show potential for enhancing AF diagnosis.
- Combining multiple atrial remodeling indices is key for effective detection.
- Integrated biomarker approaches are needed for high-risk hypertensive patients.
Background:
Atrial fibrillation (AF) is the most frequently encountered cardiac arrhythmia globally and substantially increases the risk for thromboembolic disease. Albeit, 20% of all cases of AF remain undiagnosed. On the other hand, hypertension amplifies the risk for both AF occurrences through hemodynamic and non-hemodynamic mechanisms and cerebrovascular ischemia. Under this prism, prompt diagnosis of undetected AF in hypertensive patients is of pivotal importance.
Method:
We conducted a review of the literature for studies with biomarkers that could be used in AF diagnosis as well as in predicting the transition of paroxysmal AF to sustained AF, especially in hypertensive patients.
Results:
Potential biomarkers for AF can be broadly categorized into electrophysiological, morphological and molecular markers that reflect the underlying mechanisms of adverse atrial remodeling. We focused on P-wave duration and dispersion as electrophysiological markers, and left atrial (LA) and LA appendage size, atrial fibrosis, left ventricular hypertrophy and aortic stiffness as structural biomarkers, respectively. The heterogeneous group of molecular biomarkers of AF encompasses products of the neurohormonal cascade, including NT-pro BNP, BNP, MR-pro ANP, polymorphisms of the ACE and convertases such as corin and furin. In addition, soluble biomarkers of inflammation (i.e. CRP, IL-6) and fibrosis (i.e. TGF-1 and matrix metalloproteinases) were assessed for predicting AF.
Conclusion:
The reviewed individual biomarkers might be a valuable addition to current diagnostic tools but the ideal candidate is expected to combine multiple indices of atrial remodeling in order to effectively detect both AF and adverse characteristics of high risk patients with hypertension.
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