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David Plaut: Off the Cuff

Use of cTn and BNP in Atrial Fibrillation (AF)-associated Stroke Risk

Published April 8, 2014 10:17 AM by David Plaut

Cardiac troponin (cTn), due to its superior clinical sensitivity and tissue specificity, has replaced cardiac enzymes, and is the biomarker of choice in making the critical diagnosis of an acute coronary syndrome (ACS). With increases in analytical, cTn has found utility in a number of other situations once ACS has been ruled out. Assessment of atrial fibrillation (AF)-associated stroke risk is at present mainly based on clinical risk scores such as CHADS2 and CHA2DS2-VASc, although these scores provide only modest discrimination of risk for individual patients. A recent study of cTn in patients at risk for AF-stroke stratified them based on troponin I concentrations: <0.10 ng/L, n=2663; 10-19 ng/L, n=2006; 20-39 ng/L, n=1023; ≥40 ng/L, n=497. Rates of stroke were independently related to levels of troponin I with 2.09%/year in the highest and 0.84%/year in the lowest troponin I group (hazard ratio [HR], 1.99 [95% CI, 1.17-3.39]; P=0.0040). The study also found the NT-proBNP was related to AF-stroke with 2.30%/year versus 0.92% in the highest versus quartile groups. Other biomarkers including von Willebrand factor and D-dimer in blood and proteinuria, estimated glomerular filtration rate, or creatinine clearance in urine, have also been found helpful in these patients.

posted by David Plaut

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