MicroRNAs and other biomarkers of atrial fibrillation in ischemic stroke patients

Abstract

This study aimed to evaluate the ability of selected microRNAs as biomarkers of atrial fibrillation (AF) in ischemic stroke patients in comparison with other established biochemical biomarkers. A prospective case-control study of consecutive ischemic stroke patients with AF admitted to a comprehensive stroke center was conducted. The control group consisted of patients with ischemic stroke with no AF detected on prolonged (at least 3 weeks) Holter ECG monitoring. As potential biomarkers of AF, we analyzed the plasma levels of microRNAs (miR-21, miR-29b, miR-133b, miR-142-5p, miR-150, miR-499, and miR-223-3p) and 13 biochemical biomarkers at admission. The predictive accuracy of biomarkers was assessed by calculating the area under the receiver operating characteristic curve. The data of 117 patients were analyzed (61 with AF, 56 with no AF, 46% men, median age 73 years, median National Institutes of Health Stroke Scale 6). Biochemical biomarkers (N-terminal pro-B-type natriuretic peptide [NT-proBNP], high-sensitivity cardiac troponin I, fibrinogen, C-reactive protein, eGFR, and total triglycerides) were significantly associated with AF. NT-proBNP had the best diagnostic performance for AF with area under the receiver operating characteristic curve 0.92 (95%, CI 0.86-0.98); a cutoff value of >528 ng/L had a sensitivity of 79% and a specificity of 97%. None of the other biomarkers, including microRNAs, was associated with AF. Conventional biochemical biomarkers (NT-proBNP, high-sensitivity cardiac troponin I, fibrinogen, C-reactive protein, eGFR, and triglycerides), but not microRNAs (miR-21, miR-29b, miR-133b, miR-142-5p, miR-150, miR-499, and miR-223-3p) were significantly associated with AF in our ischemic stroke cohort.

Figure 1.

Receiver operating characteristic (ROC) curves of biomarkers. (A) ROC curve of left atrial diameter, area under the curve (AUC) = 0.78. (B) ROC curve of NT-proBNP, AUC = 0.92. (C) ROC curve of hs-cTnI, AUC = 0.76. (D) ROC curve of eGFR, AUC = 0.71. (E) ROC curve of CRP, AUC = 0.67. (F) ROC curve of total triglycerides, AUC = 0.63. (G) ROC curve of fibrinogen, AUC = 0.62. (H) ROC curve of miR-150, AUC = 0.61. CRP = C-reactive protein, hs-cTnI = high-sensitivity cardiac troponin I.