Kamel Hooman, Elkind Mitchell Sv, Kronmal Richard A, Longstreth W T, Plummer Pamela, Aragon Garcia Rebeca, Broderick Joseph P, Pauls Qi, Elm Jordan J, Nahab Fadi, Janis L Scott, Di Tullio Marco R, Soliman Elsayed Z, Healey Jeff S, Tirschwell David L
Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
Department of Neurology, Columbia University, New York, NY, USA.
Eur Stroke J. 2024 Aug 30:23969873241276358. doi: 10.1177/23969873241276358.
ARCADIA compared apixaban to aspirin for secondary stroke prevention in patients with cryptogenic stroke and atrial cardiopathy. One possible explanation for the neutral result is that biomarkers used did not optimally identify atrial cardiopathy. We examined the relationship between biomarker levels and subsequent detection of AF, the hallmark of atrial cardiopathy.
Patients were randomized if they met criteria for atrial cardiopathy, defined as P-wave terminal force >5000 μV*ms in ECG lead V (PTFV), NT-proBNP >250 pg/mL, or left atrial diameter index (LADI) ⩾3 cm/m. For this analysis, the outcome was AF detected per routine care.
Of 3745 patients who consented to screening for atrial cardiopathy, 254 were subsequently diagnosed with AF; 96 before they could be randomized and 158 after randomization. In unadjusted analyses, ln(NT-proBNP) (RR per SD, 1.99; 95% CI, 1.85-2.13), PTFV (RR per SD, 1.15; 95% CI, 1.03-1.28) and LADI (RR per SD, 1.34; 95% CI, 1.20-1.50) were associated with AF. In a model containing all 3 biomarkers, demographics, and AF risk factors, age (RR per 10 years, 1.24; 95% CI, 1.09-1.41), ln(NT-proBNP) (RR per SD, 1.88; 95% CI, 1.67-2.11) and LADI (RR per SD, 1.25; 95% CI, 1.14-1.37) were associated with AF. These three variables together had a c-statistic of 0.82 (95% CI, 0.79-0.85) but only modest calibration. Discrimination was attenuated in sensitivity analyses of patients eligible for randomization who may have been more closely followed for AF.
Biomarkers used to identify atrial cardiopathy in ARCADIA were moderately predictive of subsequent AF.
ARCADIA研究比较了阿哌沙班与阿司匹林在隐源性卒中合并心房病变患者二级预防中的效果。结果呈中性的一个可能解释是所使用的生物标志物未能最佳地识别心房病变。我们研究了生物标志物水平与随后房颤（心房病变的标志）检测之间的关系。
符合心房病变标准（定义为心电图V导联P波终末电势＞5000 μV*ms、N末端B型利钠肽原＞250 pg/mL或左房直径指数≥3 cm/m）的患者被随机分组。对于本分析，结局为通过常规护理检测到的房颤。
在3745例同意筛查心房病变的患者中，254例随后被诊断为房颤；96例在随机分组前被诊断，158例在随机分组后被诊断。在未校正分析中，N末端B型利钠肽原的自然对数（每标准差的风险比，1.99；95%置信区间，1.85 - 2.13）、P波终末电势（每标准差的风险比，1.15；95%置信区间，1.03 - 1.28）和左房直径指数（每标准差的风险比，1.34；95%置信区间，1.20 - 1.50）与房颤相关。在包含所有3种生物标志物、人口统计学特征和房颤风险因素的模型中，年龄（每10岁的风险比，1.24；95%置信区间，1.09 - 1.41）、N末端B型利钠肽原的自然对数（每标准差的风险比，1.88；95%置信区间，1.67 - 2.11）和左房直径指数（每标准差的风险比，1.25；95%置信区间，1.14 - 1.37）与房颤相关。这三个变量共同的c统计量为0.82（95%置信区间，0.79 - 0.85），但校准程度一般。在对可能对房颤进行更密切随访的符合随机分组条件的患者进行的敏感性分析中，辨别力有所减弱。
ARCADIA研究中用于识别心房病变的生物标志物对随后房颤有中度预测价值。
