Biomarkers for Atrial Fibrillation Detection After Stroke: Systematic Review and Meta-analysis

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012769
Author(s):  
Alan Cameron ◽  
Huen Ki Cheng ◽  
Ren-Ping Lee ◽  
Daniel Doherty ◽  
Mark Hall ◽  
...  

Objective:To identify clinical, ECG and blood-based biomarkers associated with atrial fibrillation (AF) detection after ischaemic stroke or transient ischaemic attack (TIA) that could help inform patient selection for cardiac monitoring.Methods:We performed a systematic review and meta-analysis and searched electronic databases for cohort studies from 15/01/2000-15/01/2020. The outcome was AF ≥30 seconds within one year after ischaemic stroke/TIA. We used random effects models to create summary estimates of risk. Risk of bias was assessed using the Quality in Prognostic Studies tool. PROSPERO registration: CRD42020168307.Results:We identified 8503 studies, selected 34 studies and assessed 69 variables (42 clinical, 20 ECG and seven blood-based biomarkers). The studies included 11569 participants and AF was detected in 1478 people (12.8%). Overall, risk of bias was moderate. Variables associated with increased likelihood of AF detection are older age (OR 3.26, 95%CI 2.35-4.54), female sex (OR 1.47, 95%CI 1.23-1.77), a history of heart failure (OR 2.56, 95%CI 1.87-3.49), hypertension (OR 1.42, 95%CI 1.15-1.75) or ischaemic heart disease (OR 1.80, 95%CI 1.34-2.42), higher modified Rankin Scale (OR 6.13, 95%CI 2.93-12.84) or National Institutes of Health Stroke Scale score (OR 2.50, 95%CI 1.64-3.81), no significant carotid/intracranial artery stenosis (OR 3.23, 95%CI 1.14-9.11), no tobacco use (OR 1.93, 95%CI 1.48-2.51), statin therapy (OR 2.07, 95%CI 1.14-3.73), stroke as index diagnosis (OR 1.59, 95%CI 1.17-2.18), systolic blood pressure (OR 1.61, 95%CI 1.16-2.22), intravenous thrombolysis treatment (OR 2.40, 95%CI 1.83-3.16), atrioventricular block (OR 2.12, 95%CI 1.08-4.17), left ventricular hypertrophy (OR 2.21, 95%CI 1.03-4.74), premature atrial contraction (OR 3.90, 95%CI 1.74-8.74), maximum P-wave duration (OR 3.19, 95%CI 1.40-7.25), PR interval (OR 2.32, 95%CI 1.11-4.83), P-wave dispersion (OR 7.79, 95%CI 4.16-14.61), P-wave index (OR 3.44, 95%CI 1.87-6.32), QTc interval (OR 3.68, 95%CI 1.63-8.28), brain natriuretic peptide (OR 13.73, 95%CI 3.31-57.07) and HDL-cholesterol (OR 1.49, 95%CI 1.17-1.88) concentrations. Variables associated with reduced likelihood are minimum P-wave duration (OR 0.53, 95%CI 0.29-0.98), LDL-cholesterol (OR 0.73, 95%CI 0.57-0.93) and triglyceride (OR 0.51, 95%CI 0.41-0.64) concentrations.Discussion:We have identified multi-modal biomarkers that could help guide patient selection for cardiac monitoring after ischaemic stroke/TIA. Their prognostic utility should be prospectively assessed with AF detection and recurrent stroke as outcomes.

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alan Cameron ◽  
Huen Ki Cheng ◽  
Ren Ping Lee ◽  
Pouria Khashayar ◽  
Mark Hall ◽  
...  

Introduction: Cardiac monitoring is performed to detect atrial fibrillation (AF) after stroke. Identifying patients at high or low risk of AF may allow cardiac monitoring approaches to be tailored on a more personalised basis. We performed a systematic review and meta-analysis to identify variables associated with AF detection after ischaemic stroke. Methods: We followed the Cochrane Collaboration Guidelines and retrieved 8503 studies. After screening, 35 studies were selected and 68 variables were assessed. We assessed 41 clinical variables, 20 ECG parameters and 7 blood biomarkers associated with AF detection >30 seconds duration in the first year after stroke. Comprehensive Meta-analysis software was used to generate an odds ratio and Forest plot for each variable. Studies were assessed for quality using the Quality in Prognostic Studies (QUIPS) tool. Results: The 35 studies included 12010 patients and AF was detected in 1551 patients (13%). Of the 68 variables assessed, 20 were associated with increased odds of AF, 5 were associated with reduced odds of AF and 43 were not associated with AF (Figure 1). The variables most strongly associated with AF detection (odds ratio >3.00) were older age, patients who received IV thrombolytic therapy, maximum P-wave duration, premature atrial complexes, P-wave dispersion, P-wave index, QTc interval and brain natriuretic peptide. Risk of bias was low in 3 studies, moderate in 24 studies and high in 8 studies. Conclusions: We have identified clinically applicable variables that can stratify the probability of AF detection after stroke. Our results will help guide more personalised approaches to cardiac monitoring for AF detection after stroke.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Martinez-Selles ◽  
R Elosua ◽  
M Ibarrola ◽  
M De Andres ◽  
P Diez-Villanueva ◽  
...  

Abstract Background Advanced interatrial block (IAB), prolonged and bimodal P waves in surface ECG inferior leads, is an unrecognized surrogate of atrial dysfunction and a trigger of atrial dysrhythmias, mainly atrial fibrillation (AF). Our aim was to prospectively assess whether advanced IAB in sinus rhythm precedes AF and stroke in elderly outpatients with structural heart disease, a group not previously studied. Methods Prospective observational registry that included outpatients aged ≥70 years with structural heart disease and no previous diagnosis of AF. Patients were divided into three groups according to P-wave characteristics. Results Among 556 individuals, 223 had normal P-wave (40.1%), 196 partial IAB (35.3%), and 137 advanced IAB (24.6%). After a median follow-up of 694 days; 93 patients (16.7%) developed AF, 30 stroke (5.4%), and 34 died (6.1%). Advanced IAB was independently associated with AF (hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.7–5.1, p<0.001), stroke (HR 3.8, 95% CI 1.4–10.7, p=0.010), and AF/stroke (HR 2.6, 95% CI 1.5–4.4, p=0.001). P-wave duration (ms) was independently associated with AF (HR 1.05, 95% CI 1.03–1.07, p<0.001), AF/stroke (HR 1.04, 95% CI 1.02–1.06, p<0.001), and mortality (HR 1.04, 95% CI 1.00–1.08, p=0.021). Conclusions The presence of advanced IAB in sinus rhythm is a risk factor for AF and stroke in an elderly population with structural heart disease and no previous diagnosis of AF. P-wave duration was also associated with all-cause mortality. Figure. Age- and sex-adjusted linear and non-linear association between P-wave duration (msec) and atrial fibrillation (A), stroke (B), and atrial fibrillation or stroke (C) risk. Results of a generalized additive model with spline smoothing functions and 4 degrees of freedom. Figure 1. Kaplan-Meyer curves of survival free of atrial fibrillation (A), stroke (B) and atrial fibrillation or stroke (C) in patients with normal P-wave, partial interatrial block (IAB) and advanced IAB. Funding Acknowledgement Type of funding source: None


Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S31-S32
Author(s):  
Michael Gardner ◽  
Shruti Bidani ◽  
Muzammil Khan ◽  
Jianhui Zhu ◽  
William W. Barrington ◽  
...  

Heart Rhythm ◽  
2005 ◽  
Vol 2 (5) ◽  
pp. S182-S183
Author(s):  
Brian Nilsson ◽  
Ulrik Dixen ◽  
Xu Chen ◽  
Steen Pehrson ◽  
Jesper H. Svendsen

2011 ◽  
Vol 5 ◽  
pp. 806-812 ◽  
Author(s):  
Andrzej Bissinger ◽  
Tomasz Grycewicz ◽  
Wlodzimierz Grabowicz ◽  
Andrzej Lubinski

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