Cardiac Blood-Based Biomarkers of Myocardial Stress as Predictors of Atrial Fibrillation Development in Patients With ESUS or Cryptogenic Stroke: A Systematic Review and Meta-analysis

Abstract

Background and Purpose: Despite all efforts to categorize a stroke's etiology, the underlying cause is frequently still unknown. Atrial fibrillation (AF) is a major risk factor for stroke that may go undiagnosed in patients with embolic stroke of undetermined source (ESUS) or cryptogenic stroke (CS). Early diagnosis is crucial for stroke prognosis and secondary prevention. This systematic review aims to determine whether blood biomarkers of myocardial stress may accurately predict AF in patients with ESUS/CS, allowing for the identification of patients who would benefit from closer monitoring. Methods: In February 2023, we performed a systematic date-unrestricted search in three databases for observational studies on patients who had ESUS/CS and were then diagnosed with AF. Following that, the relationship between AF and cardiac blood-based myocardial stress markers such as BNP, N-terminal-pro-BNP (NTproBNP), Mid-regional pro-atrial natriuretic peptide (MR-proANP) and Troponin was examined. Results: This review identified 1527 studies and 23 were eligible. The capability of these markers to predict the diagnosis of AF was assessed in 6212 participants, with AF diagnosed in 864. When adjusted data was used, the increased likelihood of AF detection was 3.06 when (NT-pro)BNP levels were higher. It was 9.03 when raw data was used. When present, negative predictive value (NPV) had consistently higher values. The post-test probability was 8%. Conclusion: Although higher values of the studied biomarkers are associated with the diagnosis of AF after stroke, more homogeneous studies are needed to fully assess these biomarkers' potential. When monitoring patients with ESUS/CS for AF, it is important to emphasize the importance of biomarkers as potential excluders.