Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May;30(5):1352-1363.
doi: 10.1111/ene.15746. Epub 2023 Mar 10.

Biomarkers predictive of atrial fibrillation in patients with cryptogenic stroke. Insights from the Nordic Atrial Fibrillation and Stroke (NOR-FIB) study

Anna Tancin Lambert  1   2 , Barbara Ratajczak-Tretel  1   2 , Riadh Al-Ani  3 , Kathrine Arntzen  4 , Grete Kristin Bakkejord  4 , Hanna Marie Otterholt Bekkeseth  5 , Vigdis Bjerkeli  6 , Guttorm Eldøen  7 , Anne Kristine Gulsvik  8 , Bente Halvorsen  2   6 , Gudrun Anette Høie  3 , Hege Ihle-Hansen  9 , Håkon Ihle-Hansen  10 , Susanne Ingebrigtsen  11 , Henriette Johansen  12 , Christine Kremer  13   14 , Siv Bohne Krogseth  15 , Christina Kruuse  16 , Martin Kurz  17 , Ingvild Nakstad  18 , Vojtech Novotny  19 , Halvor Naess  19 , Rehman Qazi  8 , Mehdi Kallaj Rezai  17 , Dag Marius Rørholt  7 , Linn Hofsøy Steffensen  11 , Jesper Sømark  5   12 , Håkon Tobro  20 , Thomas Clement Truelsen  21 , Lejla Wassvik  22 , Karen Lehrmann AEgidius  22 , Maiju Pesonen  23 , Mirko de Melis  24 , Dan Atar  2   25 , Anne Hege Aamodt  12 ; NOR-FIB Study Group
Affiliations

Biomarkers predictive of atrial fibrillation in patients with cryptogenic stroke. Insights from the Nordic Atrial Fibrillation and Stroke (NOR-FIB) study

Anna Tancin Lambert et al. Eur J Neurol. 2023 May.

Abstract

Background and purpose: There are currently no biomarkers to select cryptogenic stroke (CS) patients for monitoring with insertable cardiac monitors (ICMs), the most effective tool for diagnosing atrial fibrillation (AF) in CS. The purpose of this study was to assess clinically available biomarkers as predictors of AF.

Methods: Eligible CS and cryptogenic transient ischaemic attack patients underwent 12-month monitoring with ICMs, clinical follow-up and biomarker sampling. Levels of cardiac and thromboembolic biomarkers, taken within 14 days from symptom onset, were compared between patients diagnosed with AF (n = 74) during monitoring and those without AF (n = 185). Receiver operating characteristic curves were created. Biomarkers reaching area under the receiver operating characteristic curve ≥ 0.7 were dichotomized by finding optimal cut-off values and were used in logistic regression establishing their predictive value for increased risk of AF in unadjusted and adjusted models.

Results: B-type natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase, D-dimer and high-sensitivity cardiac troponin I and T were significantly higher in the AF than non-AF group. BNP and NT-proBNP reached the predefined area under the curve level, 0.755 and 0.725 respectively. Optimal cut-off values were 33.5 ng/l for BNP and 87 ng/l for NT-proBNP. Regression analysis showed that NT-proBNP was a predictor of AF in both unadjusted (odds ratio 7.72, 95% confidence interval 3.16-18.87) and age- and sex-adjusted models (odds ratio 4.82, 95% confidence interval 1.79-12.96).

Conclusion: Several clinically established biomarkers were associated with AF. NT-proBNP performed best as AF predictor and could be used for selecting patients for long-term monitoring with ICMs.

Keywords: atrial fibrillation; biomarkers; cardiac rhythm monitoring; cryptogenic stroke; insertable cardiac monitors.

PubMed Disclaimer

References

REFERENCES

    1. Noubiap JJ, Agbaedeng TA, Kamtchum-Tatuene J, et al. Rhythm monitoring strategies for atrial fibrillation detection in patients with cryptogenic stroke: a systematic review and meta-analysis. IJC Heart Vasc. 2021;34:100780.
    1. Ratajczak-Tretel B, Tancin Lambert A, Al-Ani R, et al. Atrial fibrillation in cryptogenic stroke and TIA patients in the Nordic Atrial Fibrillation and Stroke (NOR-FIB) study: main results. Eur Stroke J. 2022.
    1. Brachmann J, Morillo CA, Sanna T, et al. Uncovering atrial fibrillation beyond short-term monitoring in cryptogenic stroke patients: three-year results from the cryptogenic stroke and underlying atrial fibrillation trial. Circ Arrhythm Electrophysiol. 2016;9(1):e003333.
    1. Ziegler PD, Rogers JD, Ferreira SW, et al. Long-term detection of atrial fibrillation with insertable cardiac monitors in a real-world cryptogenic stroke population. Int J Cardiol. 2017;244:175-179.
    1. Sposato LA, Cipriano LE, Saposnik G, Ruiz Vargas E, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2015;14(4):377-387.

Publication types