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Published on: July 20, 2022
Biomarker, Imaging, and Clinical Factors Associated With Overt and Covert Stroke in Patients With Atrial Fibrillation
Gian Marco De Marchis1,2,3, Philipp Krisai4, Laura Werlen2
1Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.).
Insights
A new model combining MRI white matter lesion volume and blood markers better predicts stroke risk in atrial fibrillation patients than the CHA₂DS₂-VASc score. This multimodal approach offers improved insights for stroke prevention strategies.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Atrial fibrillation (AF) is a significant risk factor for stroke and silent brain infarcts.
- The CHA₂DS₂-VASc score is a standard tool for assessing stroke risk in AF patients.
- Current risk stratification may not fully capture the risk of stroke or brain infarcts in AF.
Purpose of the Study:
- To evaluate if a multimodal approach, including MRI and biomarkers, improves stroke risk prediction in AF patients compared to the CHA₂DS₂-VASc score.
- To identify novel predictors of stroke and new brain infarcts in AF patients over a 2-year follow-up period.
Main Methods:
- The Swiss-AF study is a prospective, multicenter cohort study.
- Patients with AF and available brain MRI at baseline and 2-year follow-up were included.
- A multivariable logistic regression model incorporating clinical, biomarker, and MRI variables was compared to the CHA₂DS₂-VASc score for predicting a composite outcome of stroke or new brain infarcts.
Main Results:
- The study included 1232 AF patients, with 6.3% experiencing the primary outcome.
- Key predictors identified were white matter lesion volume, NT-proBNP, GDF-15, serum creatinine, IL-6, and hFABP.
- The multimodal model demonstrated superior performance (C-statistic 0.82) compared to the CHA₂DS₂-VASc score (C-statistic 0.64).
Conclusions:
- A model integrating baseline MRI white matter lesion volume and specific blood biomarkers provides enhanced prediction of residual stroke risk in AF patients.
- This multimodal approach offers valuable insights beyond the CHA₂DS₂-VASc score, even in patients on oral anticoagulants.
- Findings may inform the development of more effective preventive strategies for stroke in AF.
Background:
Atrial fibrillation is a major risk factor for stroke and silent brain infarcts. We studied whether a multimodal approach offers additional insights to the CHA2DS2-VASc score in predicting stroke or new brain infarcts on magnetic resonance imaging (MRI) over a 2-year follow-up.
Methods:
Swiss-AF is a prospective, multicenter cohort study of patients with known atrial fibrillation. We included patients with available brain MRI both at enrollment and 2 years later. The dates of the baseline and follow-up visits ranged from March 2014 to November 2020. The primary outcome was assessed 2 years after baseline and was defined as a composite of clinically identified stroke or any new brain infarct on the 2-year MRI. We compared a multivariable logistic regression model including prespecified clinical, biomarker, and baseline MRI variables to the CHA2DS2-VASc score.
Results:
We included 1232 patients, 89.8% of them taking oral anticoagulants. The primary outcome occurred in 78 patients (6.3%). The following baseline variables were included in the final multivariate model and were significantly associated with the primary outcome: white matter lesion volume in milliliters (adjusted odds ratio [aOR], 1.91 [95% CI, 1.45-2.56]), NT-proBNP (N-terminal pro-B-type natriuretic peptide; aOR, 1.75 [95% CI, 1.20-2.63]), GDF-15 (growth differentiation factor-15; aOR, 1.68 [95% CI, 1.11-2.53]), serum creatinine (aOR, 1.50 [95% CI, 1.02-2.22]), IL (interleukin)-6 (aOR, 1.37 [95% CI, 1.00-1.86]), and hFABP (heart-type fatty acid-binding protein; aOR, 0.48 [95% CI, 0.31-0.73]). Overall performance and discrimination of the new model was superior to that of the CHA2DS2-VASc score (C statistic, 0.82 [95% CI, 0.77-0.87] versus 0.64 [95% CI, 0.58-0.70]).
Conclusions:
In patients with atrial fibrillation, a model incorporating white matter lesion volume on baseline MRI and selected blood markers yielded new insights on residual stroke risk despite a high proportion of patients on oral anticoagulants. This may be relevant to develop further preventive measures.
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