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Updated: Jun 30, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Biomarkers for predicting atrial fibrillation: An explorative sub-analysis of the randomised SCREEN-AF trial
Katharina Schmalstieg-Bahr1,2, David J Gladstone3,4, Eva Hummers2,5
1Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
Biomarkers like natriuretic peptides and high-sensitive Troponin I may help identify individuals with undiagnosed atrial fibrillation (AF). Higher levels of these markers were observed in patients who developed AF, suggesting their potential utility in screening strategies.
Area of Science:
- Cardiology
- Biomarker Research
- Stroke Prevention
Background:
- Atrial fibrillation (AF) is a significant, treatable risk factor for stroke.
- Screening for paroxysmal AF in primary care settings presents challenges.
- Biomarkers may offer a more effective approach to AF screening strategies.
Purpose of the Study:
- To investigate the predictive value of six blood biomarkers for paroxysmal atrial fibrillation.
- To assess the utility of biomarkers in identifying individuals at risk for AF within a general practice population.
Main Methods:
- A sub-study of the SCREEN-AF randomized controlled trial (RCT) conducted in Germany.
- Ambulatory individuals aged 75+ with hypertension but no known AF were enrolled.
- Plasma levels of hsTnI, BNP, NT-pro BNP, NT-ANP, MR-pro ANP, and CRP were measured at randomization to predict AF within six months.
Main Results:
- Five biomarkers (BNP, NT-pro BNP, NT-ANP, MR-pro ANP, hsTnI) showed significantly higher median levels in patients who developed AF.
- CRP levels did not differ significantly between patients with and without AF.
- Blood samples were available from 96.7% of participants, with 3% diagnosed with AF.
Conclusions:
- Elevated natriuretic peptide levels and hsTnI are associated with the presence of atrial fibrillation.
- These biomarkers may aid in selecting patients for targeted AF screening.
- Larger clinical trials are warranted to validate these findings and refine screening protocols.
Background:
Atrial fibrillation (AF) is a common treatable risk factor for stroke. Screening for paroxysmal AF in general practice is difficult, but biomarkers might help improve screening strategies.
Objectives:
We investigated six blood biomarkers for predicting paroxysmal AF in general practice.
Methods:
This was a pre-specified sub-study of the SCREEN-AF RCT done in Germany. Between 12/2017-03/2019, we enrolled ambulatory individuals aged 75 years or older with a history of hypertension but without known AF. Participants in the intervention group received active AF screening with a wearable patch, continuous ECG monitoring for 2x2 weeks and usual care in the control group. The primary endpoint was ECG-confirmed AF within six months after randomisation. High-sensitive Troponin I (hsTnI), brain natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-pro BNP), N-terminal pro atrial natriuretic peptide (NT-ANP), mid-regional pro atrial natriuretic peptide (MR-pro ANP) and C-reactive protein (CRP) plasma levels were investigated at randomisation for predicting AF within six months after randomisation.
Results:
Blood samples were available for 291 of 301 (96.7%) participants, including 8 with AF (3%). Five biomarkers showed higher median results in AF-patients: BNP 78 vs. 41 ng/L (p = 0.012), NT-pro BNP 273 vs. 186 ng/L (p = 0.029), NT-proANP 4.4 vs. 3.5 nmol/L (p = 0.027), MR-pro ANP 164 vs. 125 pmol/L (p = 0.016) and hsTnI 7.4 vs. 3.9 ng/L (p = 0.012). CRP levels were not different between groups (2.8 vs 1.9 mg/L, p = 0.1706).
Conclusion:
Natriuretic peptide levels and hsTnI are higher in patients with AF than without and may help select patients for AF screening, but larger trials are needed.
