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Predictive Markers of Atrial Fibrillation in Patients with Transient Ischemic Attack
Kenneth Bruun Pedersen1, Charlotte Madsen2, Niels C F Sandgaard1
1Department of Cardiology, Odense University Hospital, Denmark.
Insights
Atrial fibrillation (AF) detection in stroke patients is crucial. Atherosclerosis markers like carotid intima-media thickness and coronary artery calcium scores are poor predictors of AF. Brain natriuretic peptide (BNP) showed some predictive value.
Area of Science:
- Cardiology
- Neurology
- Biomarkers
Background:
- Atrial fibrillation (AF) is a leading cause of cardio-embolism in stroke and transient ischemic attack (TIA) patients.
- Long-term monitoring for AF using insertable cardiac monitors (ICMs) is possible but requires careful patient selection due to resource limitations.
- AF is linked to atherosclerosis, suggesting atherosclerosis markers might guide AF monitoring.
Purpose of the Study:
- To evaluate atherosclerosis markers (carotid intima-media thickness, carotid plaques, coronary artery calcium score) and serum biomarkers for predicting AF in TIA patients.
- To assess the utility of these markers in guiding patient selection for AF monitoring.
Main Methods:
- One hundred fourteen TIA patients without AF were monitored using ECG, 72-hour Holter, and ICM for a median of 2.2 years.
- Carotid intima-media thickness, carotid plaques, coronary artery calcium score, and serum biomarkers (including BNP) were analyzed.
- Statistical analysis compared patients who developed AF versus those who did not.
Main Results:
- Patients who developed AF were older but shared similar comorbidities with non-AF patients.
- Thicker carotid intima-media and presence of carotid plaques were observed in AF patients, but this difference disappeared after adjusting for age and sex.
- No significant difference in coronary artery calcium score was found. Elevated brain natriuretic peptide (BNP) levels were associated with a higher likelihood of AF (OR 5.96).
Conclusions:
- Carotid intima-media thickness and coronary artery calcium score are poor predictors of AF in TIA patients.
- Serum biomarkers, except for BNP, showed no significant predictive value for AF in this cohort.
- Larger studies are needed to confirm the predictive role of BNP and other potential biomarkers for AF in TIA patients.
Background:
Atrial fibrillation (AF) is a major cause of cardio-embolism in patients with stroke and transient ischemic attack (TIA). Insertable cardiac monitors (ICM) make long-term monitoring for AF possible, but limited health care resources make patient selection important. AF is associated with atherosclerosis and markers of this could potentially be used to guide AF monitoring.
Methods And Results:
One-hundred fourteen TIA-patients without AF were thoroughly monitored for AF with ECG, 72-hour Holter monitoring and ICM with a median monitoring time of 2.2 years. Patients with AF (n = 18) were significantly older than patients without AF (age 71.1 versus 64.4 years, P = .008) but were otherwise similar in regards to comorbidities. AF patients had significantly thicker carotid intima-media and also more often presence of carotid plaques than patients without AF, but no difference was found after adjusting for age and sex. No difference in noncontrast cardiac CT calculated coronary artery calcium score was found between the 2 groups. Serum biomarkers did not differ between groups, except for brain natriuretic peptide (BNP), where patients with BNP in the upper tertile were more likely to have AF than patients with BNP in the lowest tertile, odds ratio 5.96 (95% confidence interval 1.04-34.07, P = .045).
Conclusions:
Carotid intima-media thickness and coronary artery calcium score were poor predictors of AF in patients with TIA. Apart from BNP, the examined biomarkers (hs-CRP, MR-proADM, c-TnI, copeptin) had no predictive value, but larger scale studies are needed to confirm these findings.
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