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Atrial cardiopathy biomarkers and atrial fibrillation in the ARCADIA trial.
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.
Affiliation
  • Kamel H; Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
  • Elkind MS; Department of Neurology, Columbia University, New York, NY, USA.
  • Kronmal RA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
  • Longstreth WT; Departments of Biostatistics, University of Washington, Seattle, WA, USA.
  • Plummer P; Neurology, University of Washington, Seattle, WA, USA.
  • Aragon Garcia R; Medicine, University of Washington, Seattle, WA, USA.
  • Broderick JP; Epidemiology, University of Washington, Seattle, WA, USA.
  • Pauls Q; Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
  • Elm JJ; Department of Neurology, Columbia University, New York, NY, USA.
  • Nahab F; Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
  • Janis LS; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
  • Di Tullio MR; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
  • Soliman EZ; Departments of Neurology and Pediatrics, Emory University, Atlanta, GA, USA.
  • Healey JS; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
  • Tirschwell DL; Division of Cardiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Eur Stroke J ; : 23969873241276358, 2024 Aug 30.
Article in En | MEDLINE | ID: mdl-39212178
ABSTRACT

BACKGROUND:

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.

METHODS:

Patients were randomized if they met criteria for atrial cardiopathy, defined as P-wave terminal force >5000 µV*ms in ECG lead V1 (PTFV1), NT-proBNP >250 pg/mL, or left atrial diameter index (LADI) ⩾3 cm/m2. For this analysis, the outcome was AF detected per routine care.

RESULTS:

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), PTFV1 (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.

CONCLUSIONS:

Biomarkers used to identify atrial cardiopathy in ARCADIA were moderately predictive of subsequent AF.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Eur Stroke J Year: 2024 Document type: Article Affiliation country: United States Country of publication: United kingdom

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Eur Stroke J Year: 2024 Document type: Article Affiliation country: United States Country of publication: United kingdom