Biomarker, Imaging, and Clinical Factors Associated With Overt and Covert Stroke in Patients With Atrial Fibrillation-Reference-Cited by-同舟云学术

Biomarker, Imaging, and Clinical Factors Associated With Overt and Covert Stroke in Patients With Atrial Fibrillation

Published:2023-10 Issue:10 Volume:54 Page:2542-2551
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

De Marchis Gian Marco¹²³^ORCID,Krisai Philipp⁴^ORCID,Werlen Laura²^ORCID,Sinnecker Tim¹⁵,Aeschbacher Stefanie²^ORCID,Dittrich Tolga D.¹²³^ORCID,Polymeris Alexandros A.¹^ORCID,Coslovksy Michael²⁴^ORCID,Blum Manuel R.⁶⁷^ORCID,Rodondi Nicolas⁶⁷^ORCID,Reichlin Tobias⁸^ORCID,Moschovitis Giorgio⁹^ORCID,Wuerfel Jens⁵^ORCID,Lyrer Philippe A.¹²^ORCID,Fischer Urs¹²¹⁰^ORCID,Conen David¹¹^ORCID,Kastner Peter¹²^ORCID,Ziegler André¹²^ORCID,Osswald Stefan⁴^ORCID,Kühne Michael¹³^ORCID,Bonati Leo H.¹²¹⁴^ORCID,

Affiliation:

1. Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.).

2. Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland.

3. Department of Neurology and Stroke Center, Kantonsspital St.Gallen, Switzerland (G.M.D.M., T.D.D.).

4. Cardiology Division, Department of Medicine, University Hospital Basel, Switzerland (P.K., M.C., S.O., M.K.).

5. Department of Biomedical Engineering, Medical Image Analysis Center AG and Qbig (T.S., J.W.), University of Basel, Switzerland.

6. Institute of Primary Health Care (BIHAM) (M.R.B., N.R.), University of Bern, Switzerland.

7. Department of General Internal Medicine, Inselspital, Bern University Hospital (M.R.B., N.R.), University of Bern, Switzerland.

8. Department of Cardiology, Inselspital, Bern University Hospital (T.R.), University of Bern, Switzerland.

9. Cardiology Division, Ente Ospedaliero Cantonale, Istituto Cardiocentro Ticino, Regional Hospital of Lugano, Switzerland (G.M.).

10. Department of Neurology, University Hospital Bern, Switzerland (U.F.).

11. Population Health Research Institute, McMaster University, Hamilton, Canada (D.C.).

12. Roche Diagnostics GmbH, Penzberg, Germany (P.K., A.Z.).

13. Cardiovascular Research Institute Basel, Switzerland (P.K., S.A., S.O., M.K.).

14. Rheinfelden Rehabilitation Clinic, Switzerland (L.H.B.).

Abstract

BACKGROUND: Atrial fibrillation is a major risk factor for stroke and silent brain infarcts. We studied whether a multimodal approach offers additional insights to the CHA 2 DS 2 -VASc score in predicting stroke or new brain infarcts on magnetic resonance imaging (MRI) over a 2-year follow-up. METHODS: Swiss-AF is a prospective, multicenter cohort study of patients with known atrial fibrillation. We included patients with available brain MRI both at enrollment and 2 years later. The dates of the baseline and follow-up visits ranged from March 2014 to November 2020. The primary outcome was assessed 2 years after baseline and was defined as a composite of clinically identified stroke or any new brain infarct on the 2-year MRI. We compared a multivariable logistic regression model including prespecified clinical, biomarker, and baseline MRI variables to the CHA 2 DS 2 -VASc score. RESULTS: We included 1232 patients, 89.8% of them taking oral anticoagulants. The primary outcome occurred in 78 patients (6.3%). The following baseline variables were included in the final multivariate model and were significantly associated with the primary outcome: white matter lesion volume in milliliters (adjusted odds ratio [aOR], 1.91 [95% CI, 1.45–2.56]), NT-proBNP (N-terminal pro-B-type natriuretic peptide; aOR, 1.75 [95% CI, 1.20–2.63]), GDF-15 (growth differentiation factor-15; aOR, 1.68 [95% CI, 1.11–2.53]), serum creatinine (aOR, 1.50 [95% CI, 1.02–2.22]), IL (interleukin)-6 (aOR, 1.37 [95% CI, 1.00–1.86]), and hFABP (heart-type fatty acid–binding protein; aOR, 0.48 [95% CI, 0.31–0.73]). Overall performance and discrimination of the new model was superior to that of the CHA 2 DS 2 -VASc score (C statistic, 0.82 [95% CI, 0.77–0.87] versus 0.64 [95% CI, 0.58–0.70]). CONCLUSIONS: In patients with atrial fibrillation, a model incorporating white matter lesion volume on baseline MRI and selected blood markers yielded new insights on residual stroke risk despite a high proportion of patients on oral anticoagulants. This may be relevant to develop further preventive measures.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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