Hatab Isra, Kneihsl Markus, Arnold Markus, Pokorny Thomas, Westphal Laura P, Bicciato Giulio, Inauen Corinne, Bisping Egbert, Fandler-Höfler Simon, Arnold Marcel, De Marchis Gian Marco, Kahles Timo, Cereda Carlo W, Kägi Georg, Bustamante Alejandro, Montaner Joan, Ntaios George, Foerch Christian, Spanaus Katharina, von Eckardstein Arnold, Cameron Alan, Enzinger Christian, Gattringer Thomas, Fischer Urs, Katan Mira
Department of Neurology (I.H., M. Kneihsl, S.F.-H., C.E., T.G.), Medical University of Graz, Austria.
Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology (M. Kneihsl), Medical University of Graz, Austria.
Stroke. 2025 Jul;56(7):1704-1713. doi: 10.1161/STROKEAHA.124.049249. Epub 2025 Apr 21.
Atrial fibrillation detected after stroke (AFDAS) affects secondary stroke prevention, yet identification can be challenging. Easily accessible cardiac blood biomarkers such as NT-proBNP (N-terminal pro-B-type natriuretic peptide) could guide diagnostic workup, but optimal cutoff values and the time-dependent relationship between NT-proBNP and AFDAS are unclear. We aimed (1) to externally validate earlier presented NT-proBNP cutoffs for atrial fibrillation prediction and (2) to assess the time-dependent relationship of NT-proBNP and early in-hospital AFDAS versus AFDAS after discharge.
We conducted a pooled data analysis of patients with ischemic stroke from the prospective international multicenter BIOSIGNAL (Biomarker Signature of Stroke Aetiology) cohort study (European Stroke Centers from October 2014 to October 2017) and the prospective single-center Graz stroke pathway study (Austria from May 2018 to August 2020). AFDAS was defined as ≥30-s atrial fibrillation/flutter diagnosed within 1 year post-admission and categorized in in-hospital versus after discharge. NT-proBNP was assessed ≤24 hours of symptom onset. The association between NT-proBNP and AFDAS was evaluated by a multivariable logistic regression analysis.
AFDAS was diagnosed in 374 (16%) of 2292 patients with ischemic stroke (median age, 74 years; 42% female), 268 (72%) during hospitalization, and 106 (28%) after discharge (median duration of hospitalization, 15 days). NT-proBNP levels at admission had a good predictive capacity for in-hospital AFDAS (area under the receiver operating characteristic curve, 0.83 [95% CI, 0.81-0.86]). For patients diagnosed with AFDAS after discharge, the predictive capacity of NT-proBNP was poor (area under the receiver operating characteristic curve, 0.65 [95% CI, 0.60-0.70]), and 20% had normal NT-proBNP values <125 pg/mL at admission. The NT-proBNP cutoff of 505 pg/mL exhibited high sensitivity (82%) and specificity (71%) for in-hospital AFDAS, with a negative predictive value of 96%.
In patients with ischemic stroke, the admission NT-proBNP cutoff of 505 pg/mL seems to be a reliable predictor for in-hospital AFDAS, while the predictive capacity of NT-proBNP for AFDAS after discharge is limited. Our results might influence the designs of future secondary stroke prevention trials.
卒中后检测到的心房颤动（AFDAS）会影响二级卒中预防，但识别可能具有挑战性。易于获取的心脏血液生物标志物，如N末端B型利钠肽原（NT-proBNP），可指导诊断检查，但NT-proBNP的最佳临界值以及NT-proBNP与AFDAS之间的时间依赖性关系尚不清楚。我们旨在（1）对外验证先前提出的用于预测心房颤动的NT-proBNP临界值，以及（2）评估NT-proBNP与住院早期AFDAS和出院后AFDAS之间的时间依赖性关系。
我们对前瞻性国际多中心BIOSIGNAL（卒中病因生物标志物特征）队列研究（2014年10月至2017年10月的欧洲卒中中心）和前瞻性单中心格拉茨卒中路径研究（2018年5月至2020年8月的奥地利）中的缺血性卒中患者进行了汇总数据分析。AFDAS定义为入院后1年内诊断出的≥30秒心房颤动/扑动，并分为住院期间和出院后。NT-proBNP在症状发作后≤24小时进行评估。通过多变量逻辑回归分析评估NT-proBNP与AFDAS之间的关联。
在2292例缺血性卒中患者（中位年龄74岁；42%为女性）中，374例（16%）诊断为AFDAS，其中268例（72%）在住院期间诊断，106例（28%）在出院后诊断（中位住院时间15天）。入院时NT-proBNP水平对住院期间AFDAS具有良好的预测能力（受试者工作特征曲线下面积，0.83[95%CI，0.81-0.86]）。对于出院后诊断为AFDAS的患者，NT-proBNP的预测能力较差（受试者工作特征曲线下面积，0.65[95%CI，0.60-0.70]），20%的患者入院时NT-proBNP值正常<125 pg/mL。NT-proBNP临界值505 pg/mL对住院期间AFDAS具有高敏感性（82%）和特异性（71%），阴性预测值为96%。
在缺血性卒中患者中，入院时NT-proBNP临界值505 pg/mL似乎是住院期间AFDAS的可靠预测指标，而NT-proBNP对出院后AFDAS的预测能力有限。我们的结果可能会影响未来二级卒中预防试验的设计。
