Biomarkers of Atrial Fibrillation: Which One Is a True Marker?

Table 1

Main clinical study concerning the use of biomarkers in AF.

References	Design	Main findings
Knayzer et al. [22]	Prospective study of 156 consecutive patients who underwent isolated coronary artery bypass surgery	(i) Significant correlation between clinical markers of inflammation and post-cardiac surgery elevation in plasma cTnI levels; (ii) No correlation between markers and postoperative AF, and there was no correlation between postoperative plasma TnI levels and the occurrence of AF
Masson et al. [23]	Prospective study of 562 patients was performed with serial NT-pro BNP and hs-troponin measurement from randomized to perioperative supplementation with oral fish oil or placebo in the Omega-3 Fatty Acids for Prevention of Post-operative Atrial Fibrillation (OPERA) trial	(i) Univariate analysis; POAF group had higher hs-TnT level vs no-POAF groups. hs-TnT showed linear associations with POAF risk until 27 ng/mL, with no additional increase risk thereafter; (ii) Multivariate analysis; both markers failed to show the association to the risk of POAF
Koolen et al. [24]	Retrospective study of prospectively collected data. 3148 patients undergoing elective CABG were evaluated. Serial troponins were measured.	(i) Perioperative TNT is univariably associated with postoperative AF after CABG, but not independently; (ii) Further, no clinically useful cutoff point for preventive or early treatment could be identified
van den Bos et al. [34]	Prospective study of 407 patients admitted to the cardiology ward or coronary care unit with atrial fibrillation. TnI was measured serially	(i) Minor troponin I elevation was independently correlated to death, MI
Hijazi et al. [35]	Randomized controlled trial with 6,189 patients from Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial	(i) Proportion of CHADS2 score was significantly correlated with TnI levels; (ii) TnI levels correlated with adverse event of stroke and vascular mortality; (iii) Biomarkers increased the C-statistic from 0.68 to 0.72, , for a composite of thromboembolic events
Roldán et al. [36]	Cohort study with 930 patients, permanent AF, and good anticoagulation control with stabile INR values for at least 6 months (INRs, 2.0–3.0; time in therapeutic range (TTR), >70%)	TnI was associated with combination of stroke, TIA, systemic embolism, acute coronary syndrome, acute heart failure, and cardiac death
Silvet et al. [40].	Prospective study of 72 outpatients with AF and 49 control patients without AF	First study that has shown BNP levels to be significantly elevated in male and female outpatients with chronic AF compared with patients in sinus rhythm
Hijazi et al. [44]	Randomized control trial of 14,892 patients from Apixaban for the Prevention of Stroke in Subjects with Atrial Fibrillation (ARISTOTLE) trial	(i) NT-pro BNP level is elevated in the majority of patients with persistent or permanent AF; (ii) Median level of NT-pro BNP was 715 ng/mL.; (iii) NT-pro BNP improves risk stratification beyond the CHA2DS2VASc score; (iv) NT-pro BNP was not associated with bleeding risk

AF: atrial fibrillation; TnI: troponin I; TnT: troponin T; MI: myocardial infarct; BNP: brain natriuretic peptide; NT-pro BNP: N-terminal BNP (NT-pro BNP); POAF: postoperative atrial fibrillation; CABG: coronary artery bypass graft.