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Association Between Apelin and Atrial Fibrillation in Patients With High Risk of Ischemic Stroke
Allan Bohm1,2,3, Peter Snopek4,5, Lubomira Tothova6,7
1National Institute of Cardiovascular Diseases, Bratislava, Slovakia.
Insights
Apelin levels are significantly lower in patients with atrial fibrillation (AF), suggesting its potential as a biomarker to rule out AF in high-stroke-risk individuals. This could improve stroke prevention strategies.
Area of Science:
- Cardiology
- Biomarker Discovery
- Stroke Prevention
Background:
- Atrial fibrillation (AF) increases stroke risk, necessitating early anticoagulation.
- Current ECG-based screening for AF is limited by cost and inconvenience.
- Novel, accessible biomarkers are needed for efficient AF detection.
Purpose of the Study:
- To evaluate the diagnostic value of apelin as a biomarker for atrial fibrillation (AF).
- To assess apelin's utility in identifying high-stroke-risk patients who may have AF.
Main Methods:
- A multicenter, matched-cohort study involving healthy controls and high-stroke-risk patients with and without AF.
- Measurement of apelin levels in peripheral blood samples.
- Statistical analysis including ROC curve analysis and logistic regression.
Main Results:
- Apelin levels were significantly lower in patients with AF compared to non-AF and control groups (p < 0.001).
- Apelin demonstrated an AUC of 0.658 in ROC analysis for AF prediction.
- Apelin was identified as an independent predictor of AF in logistic regression models.
Conclusions:
- Apelin may serve as a valuable biomarker for ruling out AF in high-stroke-risk populations.
- This finding could lead to improved, non-invasive screening strategies for AF.
- Further research is warranted to validate apelin's role in clinical practice.
Abstract:
Background: Atrial fibrillation (AF) is associated with high risk of stroke preventable by timely initiation of anticoagulation. Currently available screening tools based on ECG are not optimal due to inconvenience and high costs. Aim of this study was to study the diagnostic value of apelin for AF in patients with high risk of stroke. Methods: We designed a multicenter, matched-cohort study. The population consisted of three study groups: a healthy control group (34 patients) and two matched groups of 60 patients with high risk of stroke (AF and non-AF group). Apelin levels were examined from peripheral blood. Results: Apelin was significantly lower in AF group compared to non-AF group (0.694 ± 0.148 vs. 0.975 ± 0.458 ng/ml, p = 0.001) and control group (0.982 ± 0.060 ng/ml, p < 0.001), respectively. Receiver operating characteristic (ROC) analysis of apelin as a predictor of AF scored area under the curve (AUC) of 0.658. Apelin's concentration of 0.969 [ng/ml] had sensitivity = 0.966 and specificity = 0.467. Logistic regression based on manual feature selection showed that only apelin and NT-proBNP were independent predictors of AF. Logistic regression based on selection from bivariate analysis showed that only apelin was an independent predictor of AF. A logistic regression model using repeated stratified K-Fold cross-validation strategy scored an AUC of 0.725 ± 0.131. Conclusions: Our results suggest that apelin might be used to rule out AF in patients with high risk of stroke.
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