Biomarkers and Risk Prediction Tools for Stroke and Dementia in Patients with Atrial Fibrillation
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ARRHYTHMIAS (J. BUNCH, SECTION EDITOR)
Biomarkers and Risk Prediction Tools for Stroke and Dementia in Patients with Atrial Fibrillation Kalyani A. Boralkar 1 & Francois Haddad 1 & Benjamin D. Horne 1,2 Accepted: 3 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review With the aging population, atrial fibrillation (AF) associations with both stroke and dementia have become a priority for the healthcare system. The purpose of this paper is to review the emerging role of clinical scores and biomarkers in the risk stratification of AF patients for risk of stroke and risk of dementia. Recent Findings AF is the most common arrhythmia in the aging population and a common comorbidity in atherosclerotic disease and heart failure. In this review, we identified 34 most relevant papers that specifically address the role of biomarkers in risk-stratifying patients with AF with regard to stroke and dementia. Recent data suggest an incremental value for biomarkers of myocardial injury, myocardial strain, and hemostasis for risk-stratifying patients at risk with AF at greater risk of stroke. Furthermore, biomarker risk scores such as the Intermountain Risk Score are emerging as complementary to the commonly used CHA2DS2-VASc score for both stroke and dementia. Imaging biomarkers including left atrial size and left atrial reservoir strain may complement these circulating biomarkers to identify patients at greater risk of stroke, and the combination of AF and evidence of subclinical stroke could further inform the risk cognitive decline. Summary Several clinical biomarker risk scores and biomarkers can complement the risk stratification of AF and dementia. With the more frequent use of anticoagulation, developing integrated risk scores for stroke and bleeding in patients with AF is now a focus of ongoing research. Early detection and intervention for cognitive decline in our aging population is also a priority for the healthcare system, and risk scores can help identify higher risk individuals. Keywords Atrial fibrillation . Stroke . Dementia . Biomarkers . Risk prediction
Introduction This article is part of the Topical Collection on Arrhythmias Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12170-020-00658-0) contains supplementary material, which is available to authorized users. * Benjamin D. Horne [email protected] Kalyani A. Boralkar [email protected] Francois Haddad [email protected] 1
Stanford University School of Medicine, Stanford, CA, USA
2
Intermountain Medical Center Heart Institute, 5121 S. Cottonwood St., Salt Lake City, UT 84107, USA
Atrial fibrillation (AF) is one of the most common major cardiac arrhythmias and produces a substantial burden on our healthcare system [1]. While AF is a strong risk factor for stroke, emerging data also suggests an association of AF with dementia [2–4]. Risk stratification for stroke in AF has been a frequent topic of research in the past, and scoring schemes a
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