Atrial ectopy and N-terminal pro-B-type natriuretic peptide as predictors of atrial fibrillation: a population-based cohort study

Kumarathurai, Preman; Mouridsen, Mette Rauhe; Mattsson, Nick; Larsen, Bjørn Strøier; Nielsen, Olav Wendelboe; Gerds, Thomas Alexander; Sajadieh, Ahmad

doi:10.1093/europace/euw017

Cited by 14 publications

(14 citation statements)

References 32 publications

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“…Second, AF might serve as an intermediary between PACs and CV outcomes. PACs independently predicted incidence of AF and significantly improved the predictive performance of Framingham AF risk model . On the other hand, PACs might be a surrogate of undetected occult paroxysmal AF in patients with stroke .…”

Section: Discussionmentioning

confidence: 89%

Relation of premature atrial complexes with stroke and death: Systematic review and meta‐analysis

Huang

Peng

et al. 2017

Clinical Cardiology

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Section: Discussionmentioning

confidence: 89%

Relation of premature atrial complexes with stroke and death: Systematic review and meta‐analysis

Huang

Peng

et al. 2017

Clinical Cardiology

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“…The FHS-AF (Framingham Heart Study risk score for AF) model had originally been derived for predicting 10-year incident AF risk, but had later been recalibrated and subsequently externally validated for 5-year risk of incident AF. 33 , 40 …”

Section: Resultsmentioning

confidence: 99%

“…All studies used the C-statistic to assess model discrimination for incident AF within their cohorts. Nine studies assessed calibration by providing both a P -value for a goodness-of-fit test and a calibration plot in at least one of the risk models that these studies reported on refs, 20 , 21 , 24 , 27 , 29 , 30 , 32 , 36 , 40 seven studies assessed calibration only by a P -value for goodness-of-fit test, 22 , 26 , 35 , 39 , 41 , 43 , 44 two studies assessed calibration only by a calibration plot, 25 , 33 and nine studies reported neither of these calibration parameters. 23 , 28 , 31 , 34 , 37 , 38 , 42 , 45 , 46 …”

Section: Resultsmentioning

confidence: 99%

Prediction models for atrial fibrillation applicable in the community: a systematic review and meta-analysis

et al. 2020

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Aims Atrial fibrillation (AF) is a common arrhythmia associated with an increased stroke risk. The use of multivariable prediction models could result in more efficient primary AF screening by selecting at-risk individuals. We aimed to determine which model may be best suitable for increasing efficiency of future primary AF screening efforts. Methods and results We performed a systematic review on multivariable models derived, validated, and/or augmented for AF prediction in community cohorts using Pubmed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) through 1 August 2019. We performed meta-analysis of model discrimination with the summary C-statistic as the primary expression of associations using a random effects model. In case of high heterogeneity, we calculated a 95% prediction interval. We used the CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) checklist for risk of bias assessment. We included 27 studies with a total of 2 978 659 unique participants among 20 cohorts with mean age ranging from 42 to 76 years. We identified 21 risk models used for incident AF risk in community cohorts. Three models showed significant summary discrimination despite high heterogeneity: CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology) [summary C-statistic 0.71; 95% confidence interval (95% CI) 0.66–0.76], FHS-AF (Framingham Heart Study risk score for AF) (summary C-statistic 0.70; 95% CI 0.64–0.76), and CHA2DS2-VASc (summary C-statistic 0.69; 95% CI 0.64–0.74). Of these, CHARGE-AF and FHS-AF had originally been derived for AF incidence prediction. Only CHARGE-AF, which comprises easily obtainable measurements and medical history elements, showed significant summary discrimination among cohorts that had applied a uniform (5-year) risk prediction window. Conclusion CHARGE-AF appeared most suitable for primary screening purposes in terms of performance and applicability in older community cohorts of predominantly European descent.

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“…The first step is to perform a prospective international registry to confirm that IAB is associated with a high risk of AF and stroke in the elderly population with heart disease [ 22 ]. After showing the magnitude of this association, the second step is to perform a randomized control trial to test the benefits of anticoagulation in patients with heart disease, sinus rhythm, and A-IAB [ 23 ], probably adding as inclusion criteria other factor related with AF and stroke as advanced age [ 24 ] and atrial ectopy [ 25 ]. Our hypothesis also opens the door to other drugs, for instance as the renin-angiotensin-aldosterone system inhibition might have a role in the reduction of the risk of developing new onset AF [ 26 ], these medications might improve prognosis of patients with advanced IAB.…”

Section: Should Anticoagulation Be Used In Some Patients With Advancementioning

confidence: 99%

Surface ECG interatrial block-guided treatment for stroke prevention: rationale for an attractive hypothesis

Luna

Martínez‐Sellés

Bayés‐Genís

et al. 2017

BMC Cardiovasc Disord

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Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with stroke, cognitive impairment, and cardiovascular death. Some predisposing factors − as aging, diabetes, hypertension − induce and maintain electrophysiological and ultrastructural remodeling that usually includes fibrosis. Interatrial conduction disturbances play a crucial role in the initiation of atrial fibrosis and in its associated complications. The diagnosis of interatrial blocks (IABs) is easy to perform using the surface ECG. IAB is classified as partial when the P wave duration is ≥120 ms, and advanced if the P wave also presents a biphasic pattern in II, III and aVF. IAB is very frequent in the elderly and, particularly in the case of the advanced type, is associated with AF, AF recurrences, stroke, and dementia. The anticoagulation in elderly patients at high risk of AF without documented arrhythmias is an open issue but recent data suggest that it might have a role, particularly in elderly patients with structural heart disease, high CHA2DS2VASc (Congestive heart failure/left ventricular dysfunction, Hypertension, Age ≥ 75 [doubled], Diabetes, Stroke [doubled] – Vascular disease, Age 65–74, and Sex category [female]), and advanced IAB. In this debate, we discuss the association of surface ECG IAB, a marker of atrial fibrosis, with AF and stroke. We also present the rationale that justifies further studies regarding anticoagulation in some of these patients.

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Atrial ectopy and N-terminal pro-B-type natriuretic peptide as predictors of atrial fibrillation: a population-based cohort study

Abstract: Atrial fibrillation risk discrimination was significantly improved by the addition of PAC to the Framingham AF risk model, but not by the addition of NT-proBNP.

Cited by 14 publications

References 32 publications

Relation of premature atrial complexes with stroke and death: Systematic review and meta‐analysis

Relation of premature atrial complexes with stroke and death: Systematic review and meta‐analysis

Prediction models for atrial fibrillation applicable in the community: a systematic review and meta-analysis

Surface ECG interatrial block-guided treatment for stroke prevention: rationale for an attractive hypothesis

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