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<p>We investigated associations of a broad biomarker panel with cognitive decline in atrial fibrillation (AF) patients to characterize possible mechanisms. We enrolled 1440 AF patients with available baseline biomarkers and cognitive testing by the Montreal Cognitive assessment (MoCA) score at inclusion and at ≥ 2 yearly follow-ups. We investigated the associations of biomarkers with cognitive decline in univariate logistic regression models, LASSO regression analysis and built a combined model. Mean age was 72&#xa0;years, 75% male, 47% paroxysmal AF. Over 4&#xa0;years, 93 patients (6.5%) had cognitive decline. These patients had more often permanent AF (32.3 vs 21.5%, <i>p</i> = 0.007) and more often a history stroke (23.7 vs 11.2%, <i>p</i> &lt; 0.001), but similar baseline MoCA scores (24.9 vs 25.3 points, <i>p</i> = 0.22) and anticoagulation rates (93.5 vs 89.5%, <i>p</i> = 0.29). The three biomarkers with the highest univariate AUC for cognitive decline were GDF-15 (0.67 [0.62–0.72]), Cystatin C (0.67 [0.61–0.72]) and high-sensitivity Troponin T (hs-TnT) (0.65 [0.60–0.70]). In LASSO regression analysis, the best cross validation included GDF-15, GFAP, ESM-1, NfL and ALAT. The combined prediction model with the highest AUC of 0.73 (0.68–0.78) included IGFBP-7, GDF-15, Cystatin C, hsCRP, ALAT, GFAP, ESM-1 and FGF23. Over 4&#xa0;years, 6.5% of AF patients had cognitive decline despite a high rate of anticoagulation. Inflammation, neuronal damage, and increased amyloid-beta might be important non-ischemic mechanisms of cognitive decline in AF patients.</p>

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Biomarker and cognitive decline in atrial fibrillation: a prospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月15日

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  • Philipp Krisai,
  • Magdalena Eberl,
  • Michael Coslovsky,
  • Nicolas Rodondi,
  • Patricia Chocano-Bedoya,
  • Stefanie Aeschbacher,
  • Sujeena Balasundaram,
  • Vinzent Rolny,
  • Richard Kobza,
  • Giorgio Moschovitis,
  • Elia Rigamonti,
  • Jürg H. Beer,
  • Andreas Müller,
  • Tobias Reichlin,
  • David Conen,
  • Stefan Osswald,
  • Leo H. Bonati,
  • Michael Kühne,
  • Stefanie Aeschbacher,
  • Chloé Auberson,
  • Steffen Blum,
  • Leo Bonati,
  • Selinda Ceylan,
  • David Conen,
  • Simone Evers-Doerpfeld,
  • Ceylan Eken,
  • Marc Girod,
  • Elisa Hennings,
  • Elena Herber,
  • Vasco Iten,
  • Philipp Krisai,
  • Michael Kühne,
  • Mirko Lischer,
  • Christine Meyer-Zürn,
  • Pascal Meyre,
  • Andreas U. Monsch,
  • Christian Müller,
  • Stefan Osswald,
  • Rebecca E. Paladini,
  • Anne Springer,
  • Christian Sticherling,
  • Thomas Szucs,
  • Gian Völlmin,
  • Drahomir Aujesky,
  • Urs Fischer,
  • Juerg Fuhrer,
  • Laurent Roten,
  • Simon Jung,
  • Heinrich Mattle,
  • Luise Adam,
  • Carole Elodie Aubert,
  • Martin Feller,
  • Axel Loewe,
  • Elisavet Moutzouri,
  • Claudio Schneider,
  • Tanja Flückiger,
  • Cindy Groen,
  • Lukas Ehrsam,
  • Sven Hellrigl,
  • Alexandra Nuoffer,
  • Damiana Rakovic,
  • Nathalie Schwab,
  • Rylana Wenger,
  • Nicolas Rodondi,
  • Tobias Reichlin,
  • Christopher Beynon,
  • Roger Dillier,
  • Michèle Deubelbeiss,
  • Franz Eberli,
  • Christine Franzini,
  • Isabel Juchli,
  • Claudia Liedtke,
  • Jacqueline Nadler,
  • Thayze Obst,
  • Jasmin Roth,
  • Fiona Schlomowitsch,
  • Xiaoye Schneider,
  • Katrin Studerus,
  • Noreen Tynan,
  • Dominik Weishaupt,
  • Andreas Müller,
  • Simone Fontana,
  • Silke Kuest,
  • Karin Scheuch,
  • Denise Hischier,
  • Nicole Bonetti,
  • Alexandra Grau,
  • Jonas Villinger,
  • Eva Laube,
  • Philipp Baumgartner,
  • Mark Filipovic,
  • Marcel Frick,
  • Giulia Montrasio,
  • Stefanie Leuenberger,
  • Franziska Rutz,
  • Jürg-Hans Beer,
  • Angelo Auricchio,
  • Adriana Anesini,
  • Cristina Camporini,
  • Giulio Conte,
  • Maria Luce Caputo,
  • Francois Regoli,
  • Tiziano Moccetti,
  • Roman Brenner,
  • David Altmann,
  • Michaela Gemperle,
  • Peter Ammann,
  • Mathieu Firmann,
  • Sandrine Foucras,
  • Martine Rime,
  • Daniel Hayoz,
  • Benjamin Berte,
  • Virgina Justi,
  • Frauke Kellner-Weldon,
  • Brigitta Mehmann,
  • Sonja Meier,
  • Myriam Roth,
  • Andrea Ruckli-Kaeppeli,
  • Ian Russi,
  • Kai Schmidt,
  • Mabelle Young,
  • Melanie Zbinden,
  • Richard Kobza,
  • Jane Frangi-Kultalahti,
  • Anica Pin,
  • Luisa Vicari,
  • Maria Luisa De Perna,
  • Giorgio Moschovitis,
  • Georg Ehret,
  • Hervé Gallet,
  • Elise Guillermet,
  • Francois Lazeyras,
  • Karl-Olof Lovblad,
  • Patrick Perret,
  • Philippe Tavel,
  • Dipen Shah,
  • Nathalie Lauriers,
  • Marie Méan,
  • Sandrine Salzmann,
  • Jürg Schläpfer,
  • Andrea Grêt,
  • Jan Novak,
  • Sandra Vitelli,
  • Frank-Peter Stephan,
  • Jane Frangi-Kultalahti,
  • Augusto Gallino,
  • Marcello Di Valentino,
  • Fabienne Witassek,
  • Matthias Schwenkglenks,
  • Jens Würfel,
  • Anna Altermatt,
  • Michael Amann,
  • Petra Huber,
  • Esther Ruberte,
  • Tim Sinnecker,
  • Vanessa Zuber,
  • Michael Coslovsky,
  • Pascal Benkert,
  • Gilles Dutilh,
  • Milica Markovic,
  • Pia Neuschwander,
  • Patrick Simon,
  • Ramun Schmid

摘要

We investigated associations of a broad biomarker panel with cognitive decline in atrial fibrillation (AF) patients to characterize possible mechanisms. We enrolled 1440 AF patients with available baseline biomarkers and cognitive testing by the Montreal Cognitive assessment (MoCA) score at inclusion and at ≥ 2 yearly follow-ups. We investigated the associations of biomarkers with cognitive decline in univariate logistic regression models, LASSO regression analysis and built a combined model. Mean age was 72 years, 75% male, 47% paroxysmal AF. Over 4 years, 93 patients (6.5%) had cognitive decline. These patients had more often permanent AF (32.3 vs 21.5%, p = 0.007) and more often a history stroke (23.7 vs 11.2%, p < 0.001), but similar baseline MoCA scores (24.9 vs 25.3 points, p = 0.22) and anticoagulation rates (93.5 vs 89.5%, p = 0.29). The three biomarkers with the highest univariate AUC for cognitive decline were GDF-15 (0.67 [0.62–0.72]), Cystatin C (0.67 [0.61–0.72]) and high-sensitivity Troponin T (hs-TnT) (0.65 [0.60–0.70]). In LASSO regression analysis, the best cross validation included GDF-15, GFAP, ESM-1, NfL and ALAT. The combined prediction model with the highest AUC of 0.73 (0.68–0.78) included IGFBP-7, GDF-15, Cystatin C, hsCRP, ALAT, GFAP, ESM-1 and FGF23. Over 4 years, 6.5% of AF patients had cognitive decline despite a high rate of anticoagulation. Inflammation, neuronal damage, and increased amyloid-beta might be important non-ischemic mechanisms of cognitive decline in AF patients.