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

Kirsty Ward, Andy Vail, Alan Cameron, Mira Katan, Gregory Y. H. Lip, Jesse Dawson, Craig J. Smith, Amit Kishore

Research output: Contribution to journalArticlepeer-review

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 Ischemic stroke (IS) /Transient Ischemic 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 hours, 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 standardized selection criteria, definition of clinically significant NDAF and laboratory assays.
Original languageEnglish
JournalEuropean Stroke Journal
Early online date6 Dec 2022
DOIs
Publication statusE-pub ahead of print - 6 Dec 2022

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