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Biomarkers for Atrial Fibrillation Detection After Stroke: Systematic Review and Meta-analysis
Alan Cameron1, Huen Ki Cheng2, Ren-Ping Lee2
1From the Institute of Cardiovascular and Medical Sciences (A.C., H.K.C., R.-P.L., D.D., M.H., P.K., T.Q., J.D.) and Institute of Neuroscience and Psychology (A.A.-R.), University of Glasgow, UK; Faculty of Medicine (H.K.C.), University of Hong Kong, Pokfulam; and Liverpool Centre for Cardiovascular Science (G.L.), University of Liverpool, UK. alan.cameron.2@glasgow.ac.uk.
Insights
This study identified clinical, ECG, and blood biomarkers predicting atrial fibrillation (AF) after stroke. These findings can help select patients for cardiac monitoring, improving stroke care and outcomes.
Area of Science:
- Cardiology
- Neurology
- Biomarker Research
Background:
- Atrial fibrillation (AF) detection after ischemic stroke or TIA is crucial for guiding cardiac monitoring.
- Identifying predictive biomarkers can optimize patient selection for monitoring.
Purpose of the Study:
- To systematically review and meta-analyze clinical, ECG, and blood-based biomarkers associated with AF detection post-ischemic stroke/TIA.
- To inform patient selection for cardiac monitoring.
Main Methods:
- Systematic review and meta-analysis of cohort studies (Jan 2000 - Jan 2020).
- Outcome: AF detection ≥30 seconds within 1 year post-stroke/TIA.
- Risk of bias assessed using the Quality in Prognostic Studies tool.
Main Results:
- 34 studies (11,569 participants) identified; 12.8% detected AF.
- Key predictors of AF: older age, female sex, heart failure history, hypertension, higher stroke severity scores, certain ECG findings (e.g., P-wave dispersion), and elevated brain natriuretic peptide.
- Reduced AF likelihood associated with lower LDL cholesterol and triglycerides.
Conclusions:
- Multimodal biomarkers identified can aid in selecting patients for cardiac monitoring post-stroke/TIA.
- Prospective assessment of these biomarkers' prognostic utility is recommended, with AF detection and recurrent stroke as outcomes.
Background And Objective:
To identify clinical, ECG, and blood-based biomarkers associated with atrial fibrillation (AF) detection after ischaemic stroke or TIA that could help inform patient selection for cardiac monitoring.
Methods:
We performed a systematic review and meta-analysis and searched electronic databases for cohort studies from January 15, 2000, to January 15, 2020. The outcome was AF ≥30 seconds within 1 year after ischemic stroke/TIA. We used random effects models to create summary estimates of risk. Risk of bias was assessed using the Quality in Prognostic Studies tool.
Results:
We identified 8,503 studies, selected 34 studies, and assessed 69 variables (42 clinical, 20 ECG, and 7 blood-based biomarkers). The studies included 11,569 participants and AF was detected in 1,478 (12.8%). Overall, risk of bias was moderate. Variables associated with increased likelihood of AF detection are older age (odds ratio [OR] 3.26, 95% confidence interval [CI] 2.35-4.54), female sex (OR 1.47, 95% CI 1.23-1.77), a history of heart failure (OR 2.56, 95% CI 1.87-3.49), hypertension (OR 1.42, 95% CI 1.15-1.75) or ischemic heart disease (OR 1.80, 95% CI 1.34-2.42), higher modified Rankin Scale (OR 6.13, 95% CI 2.93-12.84) or National Institutes of Health Stroke Scale score (OR 2.50, 95% CI 1.64-3.81), no significant carotid/intracranial artery stenosis (OR 3.23, 95% CI 1.14-9.11), no tobacco use (OR 1.93, 95% CI 1.48-2.51), statin therapy (OR 2.07, 95% CI 1.14-3.73), stroke as index diagnosis (OR 1.59, 95% CI 1.17-2.18), systolic blood pressure (OR 1.61, 95% CI 1.16-2.22), IV thrombolysis treatment (OR 2.40, 95% CI 1.83-3.16), atrioventricular block (OR 2.12, 95% CI 1.08-4.17), left ventricular hypertrophy (OR 2.21, 95% CI 1.03-4.74), premature atrial contraction (OR 3.90, 95% CI 1.74-8.74), maximum P-wave duration (OR 3.19, 95% CI 1.40-7.25), PR interval (OR 2.32, 95% CI 1.11-4.83), P-wave dispersion (OR 7.79, 95% CI 4.16-14.61), P-wave index (OR 3.44, 95% CI 1.87-6.32), QTc interval (OR 3.68, 95% CI 1.63-8.28), brain natriuretic peptide (OR 13.73, 95% CI 3.31-57.07), and high-density lipoprotein cholesterol (OR 1.49, 95% CI 1.17-1.88) concentrations. Variables associated with reduced likelihood are minimum P-wave duration (OR 0.53, 95% CI 0.29-0.98), low-density lipoprotein cholesterol (OR 0.73, 95% CI 0.57-0.93), and triglyceride (OR 0.51, 95% CI 0.41-0.64) concentrations.
Discussion:
We identified multimodal biomarkers that could help guide patient selection for cardiac monitoring after ischaemic stroke/TIA. Their prognostic utility should be prospectively assessed with AF detection and recurrent stroke as outcomes.
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