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. 2023 Mar;8(1):125-131.
doi: 10.1177/23969873221136927. Epub 2022 Dec 6.

Molecular biomarkers predicting newly detected atrial fibrillation after ischaemic stroke or TIA: A systematic review

Kirsty Ward  1 , Andy Vail  2 , Alan Cameron  3 , Mira Katan  4   5 , Gregory Yh Lip  6   7 , Jesse Dawson  3 , Craig J Smith  1   8 , Amit K Kishore  1   8
Affiliations

Molecular biomarkers predicting newly detected atrial fibrillation after ischaemic stroke or TIA: A systematic review

Kirsty Ward et al. Eur Stroke J. 2023 Mar.

Abstract

Background: Several molecular biomarkers are available that predict newly detected atrial fibrillation (NDAF). We aimed to identify such biomarkers that predict NDAF after an Ischaemic stroke (IS)/Transient Ischaemic Attack (TIA) and evaluate their performance.

Methods: A systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies of patients with IS, TIA, or both, who underwent ECG monitoring for ⩾24 h, which reported molecular biomarkers and frequency of NDAF after electronic searches of multiple databases were included.

Results: Twenty-one studies (76% IS, 24% IS and TIA) involving 4640 patients were included. Twelve biomarkers were identified, with cardiac biomarkers evaluated in the majority (75%) of patients. Performance measures were inconsistently reported. Among cohorts selecting high-risk individuals (12 studies), the most studied biomarkers were N-Terminal-Pro Brain Natriuretic Peptide (NT-ProBNP, five studies; C-statistics reported by three studies, 0.69-0.88) and Brain Natriuretic Peptide (BNP, two studies; C-statistics reported in two studies, 0.68-0.77). Among unselected cohorts (nine studies), the most studied biomarker was BNP (six studies; C-statistics reported in five studies, 0.75-0.88). Only BNP was externally validated (two studies) but using different thresholds to categorise risk of NDAF.

Conclusion: Cardiac biomarkers appear to have modest to good discrimination for predicting NDAF, although most analyses were limited by small, heterogeneous study populations. Their clinical utility should be explored further, and this review supports the need to assess the role of molecular biomarkers in large prospective studies with standardised selection criteria, definition of clinically significant NDAF and laboratory assays.

Keywords: Ischaemic stroke; atrial fibrillation; molecular biomarker; transient ischaemic attack.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JD has obtained honoraria from Medtronic, BI, BMS, Diaicchi Sankyo, Bayer, Pfizer. In addition, research support was also obtained from Pfizer and BMS. AK has obtained honoraria from Medtronic, Bayer and Abbott Inc. AC has received honoraria from BMS, Pfizer, AstraZeneca and Boeringher Ingelheim and research grants from Pfizer.

Figures

Figure 1.
Figure 1.
Study flow sheet.
See this image and copyright information in PMC

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