Chang Kay-Won, Hsu Jonathan C, Toomu Avinash, Fox Sutton, Maisel Alan S
Division of Cardiology, Department of Medicine, Veterans Affair San Diego Healthcare System, University of California, San Diego.
Division of Cardiology, Department of Medicine, Veterans Affair San Diego Healthcare System, University of California, San Diego.
Am J Med. 2017 Dec;130(12):1351-1357. doi: 10.1016/j.amjmed.2017.08.003. Epub 2017 Aug 16.
While biomarkers have greatly impacted the diagnosis and management of myocardial infarction and heart failure, the use of biomarkers has been slow to permeate management of atrial fibrillation. Guideline recommendations on the use of biomarkers in atrial fibrillation were virtually nonexistent until the 2016 European Society of Cardiology guidelines on atrial fibrillation offered a class IIb recommendation to consider using biomarkers such as high-sensitivity troponin and natriuretic peptide to further refine stroke and bleeding risk in atrial fibrillation patients. Biomarker levels have been associated with incident atrial fibrillation, postoperative atrial fibrillation, acute atrial fibrillation, diagnosis of myocardial infarction and heart failure in atrial fibrillation, and prognosis in atrial fibrillation. This review will offer an in-depth survey of current evidence on the use of biomarkers in atrial fibrillation and propose clinical algorithms to aid the internist in using biomarkers in atrial fibrillation management.
尽管生物标志物对心肌梗死和心力衰竭的诊断及管理产生了重大影响，但生物标志物在心房颤动管理中的应用推广却较为缓慢。在2016年欧洲心脏病学会关于心房颤动的指南提出IIb类推荐，建议考虑使用高敏肌钙蛋白和利钠肽等生物标志物来进一步细化心房颤动患者的卒中及出血风险之前，关于生物标志物在心房颤动中应用的指南建议几乎不存在。生物标志物水平与心房颤动的发生、术后心房颤动、急性心房颤动、心房颤动合并心肌梗死和心力衰竭的诊断以及心房颤动的预后相关。本综述将深入探讨目前关于生物标志物在心房颤动中应用的证据，并提出临床算法，以协助内科医生在心房颤动管理中使用生物标志物。
