Predictive Markers of Atrial Fibrillation in Patients with Transient Ischemic Attack |
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| Affiliation: | 2. Department of Neurology, Odense University Hospital, Denmark;3. Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark;2. Department of Neurology, The Affiliated Kunshan Hospital of Jiangsu University;3. Department of Neurological Rehabilitation, Rehabilitation Hospital of Kunshan;4. Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China;2. The Warren Alpert Medical School of Brown University, Department of Neurosurgery, Providence, Rhode Island;3. The Warren Alpert Medical School of Brown University, Department of Radiology, Providence, Rhode Island;5. Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York;4. The Warren Alpert Medical School of Brown University, Department of Internal Medicine, Division of Cardiovascular Medicine, Providence, Rhode Island;2. Department of Neurology, Harbor-UCLA Medical Center, Torrance, California;3. Department of Radiology, VA Long Beach Healthcare System, Long Beach, California;2. Division of Preventive Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan;2. Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts |
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| Abstract: | Background: Atrial fibrillation (AF) is a major cause of cardio-embolism in patients with stroke and transient ischemic attack (TIA). Insertable cardiac monitors (ICM) make long-term monitoring for AF possible, but limited health care resources make patient selection important. AF is associated with atherosclerosis and markers of this could potentially be used to guide AF monitoring. Methods and Results: One-hundred fourteen TIA-patients without AF were thoroughly monitored for AF with ECG, 72-hour Holter monitoring and ICM with a median monitoring time of 2.2 years. Patients with AF (n = 18) were significantly older than patients without AF (age 71.1 versus 64.4 years, P = .008) but were otherwise similar in regards to comorbidities. AF patients had significantly thicker carotid intima-media and also more often presence of carotid plaques than patients without AF, but no difference was found after adjusting for age and sex. No difference in noncontrast cardiac CT calculated coronary artery calcium score was found between the 2 groups. Serum biomarkers did not differ between groups, except for brain natriuretic peptide (BNP), where patients with BNP in the upper tertile were more likely to have AF than patients with BNP in the lowest tertile, odds ratio 5.96 (95% confidence interval 1.04-34.07, P = .045). Conclusions: Carotid intima-media thickness and coronary artery calcium score were poor predictors of AF in patients with TIA. Apart from BNP, the examined biomarkers (hs-CRP, MR-proADM, c-TnI, copeptin) had no predictive value, but larger scale studies are needed to confirm these findings. |
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