Measurement of Midregional Pro-Atrial Natriuretic Peptide to Discover Atrial Fibrillation in Patients With Ischemic Stroke

Schweizer, Juliane; Arnold, Markus; König, Inke R.; Bicvic, Antonela; Westphal, Laura P; Schütz, Valerie; Inauen, Corinne; Scherrer, Natalie; Luft, Andreas R.; Galovic, Marian; Ferreira‐Atuesta, Carolina; Pokorny, Thomas; Arnold, Marcel; Fischer, Urs; Bonati, Leo H.; Marchis, Gian Marco De; Kahles, Timo; Nedeltchev, Krassen; Cereda, Carlo; Kägi, Georg; Bustamante, Alejandro; Montaner, Joan; Ntaios, Georg; Sagris, Dimitrios; Foerch, Christian; Spanaus, Katharina; Eckardstein, Arnold von; Katan, Mira

doi:10.1016/j.jacc.2022.01.042

Cited by 24 publications

(27 citation statements)

References 39 publications

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“…Potential biomarkers and risk stratification scores may guide a more individualized approach for selecting patients at stroke risk for PCM as part of primary or secondary stroke prevention management. 16,44,45 Our present meta-analysis includes all RCTs that have been completed to date investigating PCM efficacy in reducing the risk of first-ever or recurrent stroke. In addition, we have included previously unpublished data on stroke occurrence from 3 RCTs.…”

Section: Discussionmentioning

confidence: 99%

Prolonged cardiac monitoring for stroke prevention: A systematic review and meta-analysis of randomized-controlled clinical trials

Tsivgoulis

Palaiodimou

Triantafyllou

et al. 2022

European Stroke Journal

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Introduction: Prolonged cardiac monitoring (PCM) substantially improves the detection of subclinical atrial fibrillation (AF) among patients with history of ischemic stroke (IS), leading to prompt initiation of anticoagulants. However, whether PCM may lead to IS prevention remains equivocal. Patients and methods: In this systematic review and meta-analysis, randomized-controlled clinical trials (RCTs) reporting IS rates among patients with known cardiovascular risk factors, including but not limited to history of IS, who received PCM for more than 7 days versus more conservative cardiac rhythm monitoring methods were pooled. Results: Seven RCTs were included comprising a total of 9048 patients with at least one known cardiovascular risk factor that underwent cardiac rhythm monitoring. PCM was associated with reduction of IS occurrence compared to conventional monitoring (Risk Ratio: 0.76; 95% CI: 0.59–0.96; I2 = 0%). This association was also significant in the subgroup of RCTs investigating implantable cardiac monitoring (Risk Ratio: 0.75; 95% CI: 0.58–0.97; I2 = 0%). However, when RCTs assessing PCM in both primary and secondary prevention settings were excluded or when RCTs investigating PCM with a duration of 7 days or less were included, the association between PCM and reduction of IS did not retain its statistical significance. Regarding the secondary outcomes, PCM was related to higher likelihood for AF detection and anticoagulant initiation. No association was documented between PCM and IS/transient ischemic attack occurrence, all-cause mortality, intracranial hemorrhage, or major bleeding. Conclusion: PCM may represent an effective stroke prevention strategy in selected patients. Additional RCTs are warranted to validate the robustness of the reported associations.

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Section: Discussionmentioning

confidence: 99%

Prolonged cardiac monitoring for stroke prevention: A systematic review and meta-analysis of randomized-controlled clinical trials

Tsivgoulis

Palaiodimou

Triantafyllou

et al. 2022

European Stroke Journal

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“…This is an interesting candidate molecular biomarker that has been shown to improve diagnostic accuracy in conjunction with several clinical risk scores, to predict NDAF after IS/TIA and needs further evaluation. 45 Data from these studies were not included in the systematic review as the CoRisk study did not specify C-statistic values with extended ECG monitoring and the results from the BIOSIGNAL study were published after our search window.…”

Section: Discussionmentioning

confidence: 99%

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

Ward

Vail

Cameron

et al. 2022

European Stroke Journal

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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.

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“…Last but not least, Schweizer et al [ 16 ] in a recent study measured MR-proANP levels in 1759 patients with acute ischemic stroke and demonstrated the association between MR-proANP levels and stroke. Interestingly, they were able to derive and validate a model to predict newly diagnosed AF (NDAF) based on age and MR-proANP levels.…”

Section: Diagnostic Applications Of Anpmentioning

confidence: 99%

Atrial Natriuretic Peptides as a Bridge between Atrial Fibrillation, Heart Failure, and Amyloidosis of the Atria

Kouibaran

Sabatino

Barozzi

et al. 2023

IJMS

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ANP is mainly synthesized by the atria, and upon excretion, it serves two primary purposes: vasodilation and increasing the renal excretion of sodium and water. The understanding of ANP’s role in cardiac systems has improved considerably in recent decades. This review focuses on several studies demonstrating the importance of analyzing the regulations between the endocrine and mechanical function of the heart and emphasizes the effect of ANP, as the primary hormone of the atria, on atrial fibrillation (AF) and related diseases. The review first discusses the available data on the diagnostic and therapeutic applications of ANP and then explains effect of ANP on heart failure (HF) and atrial fibrillation (AF) and vice versa, where tracking ANP levels could lead to understanding the pathophysiological mechanisms operating in these diseases. Second, it focuses on conventional treatments for AF, such as cardioversion and catheter ablation, and their effects on cardiac endocrine and mechanical function. Finally, it provides a point of view about the delayed recovery of cardiac mechanical and endocrine function after cardioversion, which can contribute to the occurrence of acute heart failure, and the potential impact of restoration of the sinus rhythm by extensive ablation or surgery in losing ANP-producing sites. Overall, ANP plays a key role in heart failure through its effects on vasodilation and natriuresis, leading to a decrease in the activity of the renin-angiotensin-aldosterone system, but it is crucial to understand the intimate role of ANP in HF and AF to improve their diagnosis and personalizing the patients’ treatment.

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Measurement of Midregional Pro-Atrial Natriuretic Peptide to Discover Atrial Fibrillation in Patients With Ischemic Stroke

Cited by 24 publications

References 39 publications

Prolonged cardiac monitoring for stroke prevention: A systematic review and meta-analysis of randomized-controlled clinical trials

Prolonged cardiac monitoring for stroke prevention: A systematic review and meta-analysis of randomized-controlled clinical trials

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

Atrial Natriuretic Peptides as a Bridge between Atrial Fibrillation, Heart Failure, and Amyloidosis of the Atria

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