Abstract
Background: In the last years, several studies were conducted that evaluated biomarkers that could be helpful for cardioembolic stroke diagnosis, prognosis, and the determination of risk of stroke recurrence. Methods: We performed a narrative review of the main studies that evaluated biomarkers related to specific cardioembolic causes: atrial fibrillation, patent foramen ovale, atrial cardiomyopathy, and left ventricular wall motion abnormalities. Results: BNP and NT-proBNP are, among all biomarkers of cardioembolic stroke, the ones that have the highest amount of evidence for their use. NT-proBNP is currently used for the selection of patients that will be included in clinical trials that aim to evaluate the use of anticoagulation in patients suspected of having a cardioembolic stroke and for the selection of patients to undergo cardiac monitoring. NT-proBNP has also been incorporated in tools used to predict the risk of stroke recurrence (ABC-stroke score). Conclusions: NT-proBNP and BNP continue to be the biomarkers most widely studied in the context of cardioembolic stroke. The possibility of using other biomarkers in clinical practice is still distant, mainly because of the low methodological quality of the studies in which they were evaluated. Both internal and external validation studies are rarely performed for most biomarkers.
Highlights
In many areas of medicine, biomarkers are currently used to help to diagnose, establish prognoses, and to prescribe therapeutics to specific groups of patients that benefit the most from differentiated treatments due to having particular phenotypes [1]
Cardioembolic strokes are associated to a high morbidity and mortality [5] and some like the ones associated to atrial fibrillation (AF) and to a patent foramen ovale (PFO) have specific treatments that can reduce the risk of stroke recurrence
Several biomarkers of left atrial dysfunction have been proposed for the diagnosis of atrial cardiopathy, with most of the literature referring to left atrial size, P wave dispersion, P-wave terminal force in lead V1 on EKG, paroxysmal supraventricular tachycardia, atrial high rate episodes, atrial fibrosis, and elevation of serum biomarkers associated with atrial dysfunction like NTproBNP [52,53,54]
Summary
Several biomarkers related to cardioembolism are currently being studied (Table 1). NT-proBNP and BNP are still the biomarkers that have been most studied in the context of cardioembolic stroke and for which more evidence exists. NT-proBNP and BNP have been used in clinical trials for the selection of patients. These peptides are starting to be incorporated in risk prediction scores. The majorities of other substances that are currently being evaluated as biomarkers related to cardioembolism, are far from being able to be used in clinical trials. This is mainly due to the low methodological quality of most of these studies.
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