Biomarkers for Atrial Fibrillation Detection After Stroke

Background and Objective To identify clinical, ECG, and blood-based biomarkers associated with atrial fibrillation (AF) detection after ischaemic stroke or 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 January 15, 2000, to January 15, 2020. The outcome was AF ≥30 seconds within 1 year after ischemic 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. Results We identified 8,503 studies, selected 34 studies, and assessed 69 variables (42 clinical, 20 ECG, and 7 blood-based biomarkers). The studies included 11,569 participants and AF was detected in 1,478 (12.8%). Overall, risk of bias was moderate. Variables associated with increased likelihood of AF detection are older age (odds ratio OR 3.26, 95% confidence interval 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 ischemic 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), IV 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 high-density lipoprotein 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), low-density lipoprotein cholesterol (OR 0.73, 95% CI 0.57–0.93), and triglyceride (OR 0.51, 95% CI 0.41–0.64) concentrations. Discussion We identified multimodal 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.