Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Care organisation, Northern Care Alliance NHS Foundation Trust, UK.
Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, UK.
Eur Stroke J. 2023 Mar;8(1):125-131. doi: 10.1177/23969873221136927. Epub 2022 Dec 6.
Several molecular biomarkers are available that predict newly detected atrial fibrillation (NDAF). We aimed to identify such biomarkers that predict NDAF after an Ischaemic stroke (IS)/Transient Ischaemic Attack (TIA) and evaluate their performance.
A systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies of patients with IS, TIA, or both, who underwent ECG monitoring for ⩾24 h, which reported molecular biomarkers and frequency of NDAF after electronic searches of multiple databases were included.
Twenty-one studies (76% IS, 24% IS and TIA) involving 4640 patients were included. Twelve biomarkers were identified, with cardiac biomarkers evaluated in the majority (75%) of patients. Performance measures were inconsistently reported. Among cohorts selecting high-risk individuals (12 studies), the most studied biomarkers were N-Terminal-Pro Brain Natriuretic Peptide (NT-ProBNP, five studies; C-statistics reported by three studies, 0.69-0.88) and Brain Natriuretic Peptide (BNP, two studies; C-statistics reported in two studies, 0.68-0.77). Among unselected cohorts (nine studies), the most studied biomarker was BNP (six studies; C-statistics reported in five studies, 0.75-0.88). Only BNP was externally validated (two studies) but using different thresholds to categorise risk of NDAF.
Cardiac biomarkers appear to have modest to good discrimination for predicting NDAF, although most analyses were limited by small, heterogeneous study populations. Their clinical utility should be explored further, and this review supports the need to assess the role of molecular biomarkers in large prospective studies with standardised selection criteria, definition of clinically significant NDAF and laboratory assays.
有几种分子生物标志物可用于预测新发现的心房颤动（NDAF）。我们旨在确定预测缺血性中风（IS）/短暂性脑缺血发作（TIA）后 NDAF 的此类生物标志物，并评估其性能。
根据系统评价和荟萃分析的首选报告项目（PRISMA）声明进行系统评价。纳入了接受 ⩾24 小时心电图监测的 IS、TIA 或两者均有的患者的研究，这些研究报告了分子生物标志物和电子搜索多个数据库后 NDAF 的频率。
纳入了 21 项研究（76%为 IS，24%为 IS 和 TIA），涉及 4640 名患者。确定了 12 种生物标志物，其中大多数患者评估了心脏生物标志物。性能指标的报告不一致。在选择高风险个体的队列中（12 项研究），研究最多的生物标志物是 N 端前脑利钠肽（NT-ProBNP，五项研究；三项研究报告 C 统计量，0.69-0.88）和脑利钠肽（BNP，两项研究；两项研究报告 C 统计量，0.68-0.77）。在未选择的队列中（九项研究），研究最多的生物标志物是 BNP（六项研究；五项研究报告 C 统计量，0.75-0.88）。只有 BNP 经过外部验证（两项研究），但使用不同的阈值来分类 NDAF 的风险。
心脏生物标志物似乎对预测 NDAF 具有中等至良好的区分能力，尽管大多数分析受到小而异质的研究人群的限制。应进一步探讨其临床应用价值，本综述支持在具有标准化选择标准、临床显著 NDAF 定义和实验室检测的大型前瞻性研究中评估分子生物标志物作用的必要性。
Zotero 插件