Repeated Measurements of Cardiac Biomarkers in Atrial Fibrillation and Validation of the ABC Stroke Score Over Time

Abstract

BackgroundCardiac biomarkers are independent risk markers in atrial fibrillation, and the novel biomarker–based ABC stroke score (age, biomarkers, and clinical history of prior stroke) was recently shown to improve the prediction of stroke risk in patients with atrial fibrillation. Our aim was to investigate the short‐term variability of the cardiac biomarkers and evaluate whether the ABC stroke risk score provides a stable short‐term risk estimate.Methods and ResultsAccording to the study protocol, samples were obtained at entry and also at 2 months in 4796 patients with atrial fibrillation followed for a median of 1.8 years in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. Cardiac troponin I, cardiac troponin T, and N‐terminal pro‐B‐type natriuretic peptide were measured with high‐sensitivity immunoassays. Associations with outcomes were evaluated by Cox regression. C indices and calibration plots were used to evaluate the ABC stroke score at 2 months. The average changes in biomarker levels during 2 months were small (median change cardiac troponin T +2.8%, troponin I +2.0%, and N‐terminal pro‐B‐type natriuretic peptide +13.5%) and within‐subject correlation was high (all ≥0.82). Repeated measurement of cardiac biomarkers provided some incremental prognostic value for mortality but not for stroke when combined with clinical risk factors and baseline levels of the biomarkers. Based on 8702 person‐years of follow‐up and 96 stroke/systemic embolic events, the ABC stroke score at 2 months achieved a similar C index of 0.70 (95% CI, 0.65–0.76) as compared with 0.70 (95% CI, 0.65–0.75) at baseline. The ABC stroke score remained well calibrated using predefined risk classes.ConclusionsIn patients with stable atrial fibrillation, the variability of the cardiac biomarkers and the biomarker‐based ABC stroke score during 2 months are small. The prognostic information by the ABC stroke score remains consistent and well calibrated with similar good predictive performance if patients are retested after 2 months.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984.

Association of N-terminal pro B-type natriuretic peptide (NT-proBNP) change with the risk of atrial fibrillation in the ARIC cohort

“…26, 27 Though not directly relevant, repeated measurements of NT-proBNP might provide predictive information on the risk of cardiovascular mortality among persons with AF. 28…”

Red blood cell distribution width: A marker of anisocytosis potentially associated with atrial fibrillation

“…Therefore, there is also an increasing interest in determining whether biomarkers themselves or in combination with clinical risk scores enhances prognostic accuracy for thromboembolism and mortality in AF patients[5,6]. A wide range of biomarkers have been evaluated as predictors and/or prognostics, such as cardiac troponin I and T, natriuretic peptides, D-dimer, CRP, galectin-3, growth differentiation factor-15, among others[1,5,7,8].…”

Risk factors of cardiac complications in patients with end-stage renal disease undergoing maintenance peritoneal dialysis

“…Prediction models of cardiac risk factors have been frequently used (20)(21)(22)(23), which has improved the clinical outcomes of patients. The prediction model for cardiovascular mortality can contribute to enact specific interventions (24); however, there is a lack of related study to determinate the risk factors of cardiac complications for patients on maintenance PD.…”