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Vol. 12 No. 11 (2025)
International Multidisciplinary Journal for Research & Development

Articles

NOVEL BIOMARKERS FOR RISK STRATIFICATION IN ATRIAL FIBRILLATION: A MULTICENTER PROSPECTIVE COHORT STUDY

Published 2025-11-19

  • Tursunov Ravshan Sunnatilloyevich

Tursunov Ravshan Sunnatilloyevich
Asia International University

Abstract

Background: Atrial fibrillation (AF) is associated with increased risks of stroke, heart failure, and mortality. Current risk stratification tools demonstrate suboptimal predictive accuracy, necessitating novel biomarker approaches.

Objective: To evaluate the prognostic value of cardiac biomarkers (high-sensitivity troponin T [hs-TnT], NT-proBNP, and galectin-3) in predicting adverse outcomes in AF patients.

Methods: We prospectively enrolled 1,248 patients with non-valvular AF (mean age 68.3±11.4 years, 58.2% male) across 18 centers from January 2020 to June 2022. Baseline measurements included hs-TnT, NT-proBNP, and galectin-3. Primary composite endpoint was stroke/systemic embolism, hospitalization for heart failure, or all-cause mortality during 24-month follow-up. Cox regression models assessed independent predictive value, and C-statistics evaluated discrimination beyond CHA₂DS₂-VASc score.

Results: During median follow-up of 23.8 months (IQR: 21.2-26.4), the primary endpoint occurred in 187 patients (15.0%). After multivariable adjustment, elevated hs-TnT (>14 ng/L: HR=2.42, 95% CI: 1.68-3.49, p<0.001), NT-proBNP (>900 pg/mL: HR=2.18, 95% CI: 1.52-3.12, p<0.001), and galectin-3 (>17.8 ng/mL: HR=1.86, 95% CI: 1.29-2.68, p=0.001) independently predicted outcomes. A biomarker score combining all three markers significantly improved discrimination beyond CHA₂DS₂-VASc (C-statistic: 0.78 vs. 0.64, p<0.001). Patients with all three elevated biomarkers had 4.7-fold higher event rates compared to those with none elevated (32.4% vs. 6.9%, p<0.001).

Conclusions: Cardiac biomarkers, particularly when combined, provide robust risk stratification in AF patients beyond traditional clinical scores. Integration of biomarker assessment may enhance personalized management strategies.

Keywords

atrial fibrillation, biomarkers, troponin, natriuretic peptides, galectin-3, risk stratification, prognosis

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References

  1. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation. Circulation. 2014;129(8):837-847.
  2. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults. JAMA. 2001;285(18):2370-2375.
  3. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke. Stroke. 1991;22(8):983-988.
  4. Benjamin EJ, Wolf PA, D'Agostino RB, et al. Impact of atrial fibrillation on the risk of death. Circulation. 1998;98(10):946-952.
  5. Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation. Stroke. 2010;41(12):2731-2738.
  6. Olesen JB, Torp-Pedersen C, Hansen ML, Lip GY. The value of the CHA₂DS₂-VASc score for refining stroke risk stratification. Thromb Haemost. 2012;107(6):1172-1179.
  7. Friberg L, Rosenqvist M, Lip GY. Evaluation of risk stratification schemes for ischaemic stroke in atrial fibrillation. Eur Heart J. 2012;33(12):1500-1510.
  8. Hijazi Z, Wallentin L, Siegbahn A, et al. Biomarkers in atrial fibrillation. J Am Coll Cardiol. 2013;61(22):2264-2273.
  9. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction. Circulation. 2018;138(20):e618-e651.
  10. de Lemos JA, Drazner MH, Omland T, et al. Association of troponin T detected with a highly sensitive assay and cardiac structure. JAMA. 2010;304(22):2503-2512.
  11. Jourdain P, Jondeau G, Funck F, et al. Plasma brain natriuretic peptide-guided therapy to improve outcome in heart failure. J Am Coll Cardiol. 2007;49(16):1733-1739.
  12. Zile MR, Claggett BL, Prescott MF, et al. Prognostic implications of changes in N-terminal pro-B-type natriuretic peptide in patients with heart failure. J Am Coll Cardiol. 2016;68(22):2425-2436.
  13. de Boer RA, Lok DJ, Jaarsma T, et al. Predictive value of plasma galectin-3 levels in heart failure with reduced and preserved ejection fraction. Ann Med. 2011;43(1):60-68.
  14. Ho JE, Liu C, Lyass A, et al. Galectin-3, a marker of cardiac fibrosis, predicts incident heart failure. Circ Heart Fail. 2012;5(1):72-78.
  15. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. Eur Heart J. 2021;42(5):373-498.
  16. Hicks KA, Tcheng JE, Bozkurt B, et al. 2014 ACC/AHA key data elements and definitions for cardiovascular endpoint events. J Am Coll Cardiol. 2015;66(4):403-469.
  17. Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st century. Stroke. 2013;44(7):2064-2089.
  18. Hijazi Z, Oldgren J, Siegbahn A, et al. Biomarkers in atrial fibrillation: a clinical review. Eur Heart J. 2013;34(20):1475-1480.
  19. Morrow DA, de Lemos JA. Benchmarks for the assessment of novel cardiovascular biomarkers. Circulation. 2007;115(8):949-952.
  20. Patton KK, Ellinor PT, Heckbert SR, et al. N-terminal pro-B-type natriuretic peptide is a major predictor of the development of atrial fibrillation. Circulation. 2009;120(18):1768-1774.
  21. Hijazi Z, Oldgren J, Andersson U, et al. Cardiac biomarkers are associated with an increased risk of stroke and death in patients with atrial fibrillation. Circulation. 2012;125(13):1605-1616.
  22. Clementy N, Piver E, Bisson A, et al. Galectin-3 in atrial fibrillation: mechanisms and therapeutic implications. Int J Mol Sci. 2018;19(4):976.

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