Researchers Report Clinical Risks and Biomarkers Indicative of AF

In a new study, researchers have pinpointed specific clinical risks as well as biomarkers that identify patients with atrial fibrillation (AF).

For the study, published in the European Heart Journal, 40 common cardiovascular biomarkers were measured in 638 consecutive patients (mean age 70 years; 62% [398] male; 46% [294] with AF) with AF or at least two CHA2DS2-VASc risk factors. Researchers identified clinical risk factors, imaging parameters, and biomarkers associated with AF through logistic regression with forward selection and machine learning algorithms.

Older age (bootstrapped odds ratio [OR] per year = 1.060, 95% confidence interval [1.04–1.10]; P = 0.001), male sex (OR = 2.022 [1.28–3.56], P = 0.008), and body mass index (OR per unit = 1.060 [1.02–1.12], P = 0.003) were all predictors of AF. AF was also associated with elevated brain natriuretic peptide (BNP; OR per fold change = 1.293 [1.11–1.63]; P = 0.002), elevated fibroblast growth factor-23 (FGF-23; OR = 1.667 [1.36–2.34]; P = 0.001), and reduced TNF-related apoptosis-induced ligand-receptor 2 (TRAIL-R2; OR = 0.242 [0.14–0.32]; P = 0.001). Measuring biomarkers instead of just clinical factors improved AF diagnosis (net reclassification improvement = 0.178, P < 0.001).

Study author Dr. Winnie Chua said one of AF’s biggest problems is they are not diagnosed until after a major adverse event occurs: “People with atrial fibrillation are much more likely to develop blood clots and suffer from strokes. To avoid strokes it is important for them to take anticoagulant drugs to prevent blood clotting. However, atrial fibrillation is often only diagnosed after a patient has suffered a stroke.”

By being screened, at-risk patients “can begin taking anticoagulants to prevent potentially life-threatening complications,” said Chua.

Study author Dr. Larissa Fabritz called the results “surprising,” saying in a press release, “While BNP is already a known and widely used in clinical practice biomarker, the results around the effectiveness of the FGF-23 biomarker was an unexpected and new finding. FGF-23 is only currently used in a research based environment, but we have shown how its use could be invaluable in a clinical setting.”

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Press release: https://www.eurekalert.org/pub_releases/2019-01/uob-si010319.php

Source: European Heart Journal