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Palà E, Bustamante A, Pagola J, Juega J, Francisco-Pascual J, Penalba A, Rodriguez M, De Lera Alfonso M, Arenillas JF, Cabezas JA, Pérez-Sánchez S, Moniche F, de Torres R, González-Alujas T, Clúa-Espuny JL, Ballesta-Ors J, Ribas D, Acosta J, Pedrote A, Gonzalez-Loyola F, Gentile Lorente D, Ángel Muñoz M, Molina CA, Montaner J. Blood-Based Biomarkers to Search for Atrial Fibrillation in High-Risk Asymptomatic Individuals and Cryptogenic Stroke Patients. Front Cardiovasc Med 2022; 9:908053. [PMID: 35859587 PMCID: PMC9289129 DOI: 10.3389/fcvm.2022.908053] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Atrial fibrillation (AF) increases the risk of ischemic stroke in asymptomatic individuals and may be the underlying cause of many cryptogenic strokes. We aimed to test the usefulness of candidate blood-biomarkers related to AF pathophysiology in two prospective cohorts representative of those populations. Methods Two hundred seventy-four subjects aged 65–75 years with hypertension and diabetes from the AFRICAT cohort, and 218 cryptogenic stroke patients aged >55 years from the CRYPTO-AF cohort were analyzed. AF was assessed by 4 weeks of monitoring with a wearable Holter device (NuuboTM™). Blood was collected immediately before monitoring started. 10 candidate biomarkers were measured by automated immunoassays (Roche, Penzberg) in the plasma of all patients. Univariate and logistic regression analyses were performed in each cohort separately. Results Atrial fibrillation detection rate was 12.4% (AFRICAT cohort) and 22.9% (CRYPTO-AF cohort). 4 biomarkers were significantly increased in asymptomatic individuals with AF [Troponin-T, Angiopoietin-2 (Ang-2), Endocan, and total N-terminal pro-B type natriuretic peptide (NT-proBNP)] and 7 biomarkers showed significantly higher concentrations in cryptogenic stroke patients with AF detection [growth differentiation factor 15, interleukin 6, Troponin-T, Ang-2, Bone morphogenic protein 10, Dickkopf-related protein 3 (DKK-3), and total NT-proBNP]. The models including Ang-2 and total NT-proBNP [AUC 0.764 (0.665–0.863)], and Ang-2 and DKK-3 [AUC = 0.733 (0.654–0.813)], together with age and sex, showed the best performance to detect AF in high-risk asymptomatic individuals, and in cryptogenic stroke patients, respectively. Conclusion Blood-biomarkers, in particular, total NT-proBNP, DKK-3, and Ang-2, were associated with AF reflecting two mechanistically different pathways involved in AF pathophysiology (AF stretch and vascular changes). The combination of these biomarkers could be useful in AF screening strategies in the primary care setting and also for searching AF after cryptogenic stroke.
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Affiliation(s)
- Elena Palà
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jorge Pagola
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
| | - Jesus Juega
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
| | - Jaume Francisco-Pascual
- Arrhythmia Unit-Cardiology Department, Vall d'Hebrón Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Anna Penalba
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maite Rodriguez
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
| | | | - Juan F Arenillas
- Stroke Unit, University Hospital of Valladolid, Valladolid, Spain
| | | | | | | | - Reyes de Torres
- Stroke Unit, University Hospital Virgen Macarena, Seville, Spain
| | - Teresa González-Alujas
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain.,Echocardiography Lab Cardiology Department, Vall d'Hebrón Hospital, Barcelona, Spain
| | - Josep Lluís Clúa-Espuny
- Equip d'Atenció Primària Tortosa Est, SAP Terres de l'Ebre, Institut Català de la Salut, Tortosa, Spain.,Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Ebrictus Group, Barcelona, Spain
| | - Juan Ballesta-Ors
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Ebrictus Group, Barcelona, Spain
| | - Domingo Ribas
- EAP Sant Pere i Sant Pau, DAP Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Juan Acosta
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Alonso Pedrote
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Felipe Gonzalez-Loyola
- Gerència Atenció Primària de Barcelona, Institut Català de la Salut, Barcelona, Spain.,Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Unitat Suport Recerca Barcelona, Barcelona, Spain
| | - Delicia Gentile Lorente
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Ebrictus Group, Barcelona, Spain.,Cardiology Department, Hospital Verge de la Cinta, Institut Català de la Salut, Tortosa, Spain
| | - Miguel Ángel Muñoz
- Gerència Atenció Primària de Barcelona, Institut Català de la Salut, Barcelona, Spain.,Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Unitat Suport Recerca Barcelona, Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Change in Atrial Fibrillation Burden over Time in Patients with Nonpermanent Atrial Fibrillation. Cardiol Res Pract 2020; 2020:9583409. [PMID: 32377430 PMCID: PMC7183533 DOI: 10.1155/2020/9583409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 03/16/2020] [Accepted: 03/24/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction The natural course of atrial fibrillation (AF) is not well defined. We aimed to investigate the change in AF burden over time and its associated risk factors among AF patients. Methods Fifty-four participants with recently documented paroxysmal or persistent AF were enrolled. Main exclusion criteria were permanent AF or previous catheter ablation for AF. AF burden was calculated as time in AF divided by total recording time using yearly continuous 7-day Holter-ECG recordings. A relative change ≥10% or an absolute change >0.5% in AF burden between two yearly Holter-ECG recordings was considered significant. Results Mean age was 67 years, 72% were men. The proportion of patients with no recorded AF increased from 53.7% at baseline to 78.6% (p=0.1) after 4 years of follow-up. In 7-day Holter-ECG recordings performed after baseline, 23.7% of participants had a decrease and 23.7% an increase in AF burden. In separate mixed effect models, AF burden over time was associated with prior stroke (β 42.59, 95% CI (23.40; 61.77); p < 0.0001), BNP (β 0.05, CI (0.02; 0.09); p=0.005) end-diastolic (β 0.49, CI (0.23; 0.74); p=0.0003) as well as end-systolic (β 0.25, CI (0.05; 0.46); p=0.02) left atrial volume, left atrial ejection fraction (β −0.43, CI (−0.76;−0.10); p=0.01), E-wave (β 36.67, CI (12.96; 60.38); p=0.003), and deceleration time (β −0.1, CI (−0.16; −0.05); p=0.002). In a multivariable model, a history of prior stroke (β 29.87, CI (2.61; 57.13); p=0.03) and BNP levels (β 0.05, CI (0.01; 0.08); p=0.007) remained significantly associated with AF burden. Conclusions Few patients with paroxysmal or persistent AF have AF episodes on yearly 7-day Holter-ECG recordings, and AF progression is rare. AF burden was independently associated with a history of prior stroke and BNP levels.
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Hohendanner F, Messroghli D, Bode D, Blaschke F, Parwani A, Boldt L, Heinzel FR. Atrial remodelling in heart failure: recent developments and relevance for heart failure with preserved ejection fraction. ESC Heart Fail 2018; 5:211-221. [PMID: 29457877 PMCID: PMC5880666 DOI: 10.1002/ehf2.12260] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Felix Hohendanner
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Daniel Messroghli
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
- Department of Internal Medicine—CardiologyDeutsches Herzzentrum BerlinBerlinGermany
| | - David Bode
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Florian Blaschke
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Abdul Parwani
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Leif‐Hendrik Boldt
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Frank R. Heinzel
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
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Melekhov AV, Gendlin GE, Alekseeva EM, Dadashova EF, Nikitin IG, Anisimova AV. [The frequency of cerebrovascular disorders in patients with different forms of atrial fibrillation]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:3-10. [PMID: 28665363 DOI: 10.17116/jnevro2017117323-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM To study the frequency of blood circulation disorders (BCD) in patients with different forms of atrial fibrillation (AF) and its relationship with AF duration and treatment with anticoagulants. MATERIAL AND METHODS Medical records and medical history of 1626 patients with non-valvural AF were analyzed in Moscow from 2009 to 2015. RESULTS Patients with persistent AF were older and had a higher risk of thromboembolic and hemorrhagic complications. In the group of patients with paroxysmal and persistent AF, percentage of patients with BCD (including recurrent ones) was decreased by 13.1 and 28.9% compared to the patients with persistent form. There was no correlation between AF duration and BCD frequency. The frequency of using anticoagulants was 10.8% in outpatients and 42.8% in inpatients. Patients with persistent AF received anticoagulants less frequently than patients with less persistent forms. CONCLUSION Persistent AF is associated with the higher risk of BCD. The prevention of BCD in patients with persistent AF was insufficient compared to that in patients with less persistent forms.
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Affiliation(s)
- A V Melekhov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - G E Gendlin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E M Alekseeva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E F Dadashova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - I G Nikitin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Anisimova
- Pirogov Russian National Research Medical University, Moscow, Russia
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