Biomarkers for predicting atrial fibrillation: An explorative sub-analysis of the randomised SCREEN-AF trial

Katharina Schmalstieg-Bahr; David J Gladstone; Eva Hummers; Johanna Suerbaum; Jeff S Healey; Antonia Zapf; Denise Köster; Stefanie M Werhahn; Rolf Wachter

doi:10.1080/13814788.2024.2327367

Biomarkers for predicting atrial fibrillation: An explorative sub-analysis of the randomised SCREEN-AF trial

Eur J Gen Pract. 2024 Dec;30(1):2327367. doi: 10.1080/13814788.2024.2327367. Epub 2024 Mar 18.

Authors

Katharina Schmalstieg-Bahr^{1

2}, David J Gladstone^{3

4}, Eva Hummers^{2

5}, Johanna Suerbaum^{5

6}, Jeff S Healey⁷, Antonia Zapf⁸, Denise Köster⁸, Stefanie M Werhahn⁶, Rolf Wachter^{5

6

9}

Affiliations

¹ Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.
³ Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁴ Hurvitz Brain Sciences Program, Sunnybrook Research Institute, and Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁵ DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany.
⁶ Department of Cardiology, University Medical Center Göttingen, Göttingen, Germany.
⁷ Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
⁸ Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁹ Department of Cardiology, University Hospital Leipzig, Leipzig, Germany.

Abstract

Background: Atrial fibrillation (AF) is a common treatable risk factor for stroke. Screening for paroxysmal AF in general practice is difficult, but biomarkers might help improve screening strategies.

Objectives: We investigated six blood biomarkers for predicting paroxysmal AF in general practice.

Methods: This was a pre-specified sub-study of the SCREEN-AF RCT done in Germany. Between 12/2017-03/2019, we enrolled ambulatory individuals aged 75 years or older with a history of hypertension but without known AF. Participants in the intervention group received active AF screening with a wearable patch, continuous ECG monitoring for 2x2 weeks and usual care in the control group. The primary endpoint was ECG-confirmed AF within six months after randomisation. High-sensitive Troponin I (hsTnI), brain natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-pro BNP), N-terminal pro atrial natriuretic peptide (NT-ANP), mid-regional pro atrial natriuretic peptide (MR-pro ANP) and C-reactive protein (CRP) plasma levels were investigated at randomisation for predicting AF within six months after randomisation.

Results: Blood samples were available for 291 of 301 (96.7%) participants, including 8 with AF (3%). Five biomarkers showed higher median results in AF-patients: BNP 78 vs. 41 ng/L (p = 0.012), NT-pro BNP 273 vs. 186 ng/L (p = 0.029), NT-proANP 4.4 vs. 3.5 nmol/L (p = 0.027), MR-pro ANP 164 vs. 125 pmol/L (p = 0.016) and hsTnI 7.4 vs. 3.9 ng/L (p = 0.012). CRP levels were not different between groups (2.8 vs 1.9 mg/L, p = 0.1706).

Conclusion: Natriuretic peptide levels and hsTnI are higher in patients with AF than without and may help select patients for AF screening, but larger trials are needed.

Keywords: Atrial fibrillation; ClinicalTrials.gov Identifier: NCT02392754; natriuretic peptides; prediction; primary care; screening; www.DZHK.de: SCREEN-AF DZHK15.

Plain language summary

BNP, NT-pro BNP, NT-ANP and MR-pro ANP and hsTnI levels are higher in patients with AF than without AFWith a sensitivity at 100%, BNP had the highest specificity of 60% (BNP level 50.1ng/L), followed by NT-pro BNP with a specificity of 53% (179ng/l).

MeSH terms

Atrial Fibrillation* / diagnosis
Atrial Natriuretic Factor
Biomarkers
Germany
Humans
Stroke*

Substances

Atrial Natriuretic Factor
Biomarkers

Grants and funding

The study was funded by the Canadian Stroke Prevention Intervention Network (C-SPIN), a peer-reviewed national network grant from the Canadian Institutes of Health Research (CIHR), a peer-reviewed operating grant (FKZ 81 × 1300111) from the German Centre for Cardiovascular Research (DZHK) [31], supplemented by funding from Boehringer Ingelheim and in-kind support from Microlife Corp, ManthaMed, and iRhythm. Financial support was also received from the Open Access Publication Fund of the UKE. No funding was received from the manufacturers of the used assays.