The Usefulness of Brain Damage Markers in Non-valvular Atrial Fibrillation

Abstract

Introductıon We sought to determine the possible association of stroke risk prediction models (CHA2DS2-VASc, CHADS2) and the new R2CHADS2 (The inclusion of creatinine clearance (CrCL) <60 mL/min to CHADS2) to the markers of brain ischemia and inflammation such as hsCRP and Neutrophil to Lymphocyte Ratio (NLR) in patients with non-valvular atrial fibrillation (NVAF). We tested the hypothesis that markers of subclinical brain ischemia (NSE and S100b) are higher in patients with NVAF having higher stroke risk as determined by risk prediction models.

Methods The study population included 92 patients who were seen in our outpatient clinic. End-stage hepatic or renal disease, malignancy, any prior blood transfusions, carotid artery disease, prior transient ischemic attack and ischemic or hemorrhagical stroke and oral anticoagulant usage were excluded from study. Serum levels of S100B, NSE, hs-CRP were measured by using a commercial enzyme-linked immunoassay kits and each assay was carried out in duplicate. S100B, neuron specific enolase, NSE and Hs-CRP levels were determined by using sandwich ELISA kits (Human S100B ELISA kit, BioVendor Research and Diagnostic Products; DRG,NSE ELISA; DRG, HS-CRP).The minimal measurable concentrations for these detection systems were 50 pg/ml for S100B, 1 ng/ml for NSE, and 0.1 mg/L for Hs-CRP. Intra and inter assay variabilities for each marker were 4.4% and 11.2% for NSE, 7.5% and 4.1% for Hs-CRP and 3.8% and 10.1% for S100b.

Results The patients were divided into three group according to their CHA2DS2Vasc score as follows; score under <2, score 3-4,and score >4. There were no significant differences among the groups in terms of Hs-Rcp and NLR. We showed outstanding findings in NSE and S100b values that patients with CHA2DS2VASc scores higher than 4 had significantly higher values of brain damage marker than patients with the scores of below 2 (23.2 ± 15.8 ng/ml vs. 32.6 ± 28.9 ng/ml vs. 44.4 ng/ml ± 35.4 p=0.022 and 161 ± 62 pg/ml vs.186 ± 37 pg/ml vs.189 ± 25 pg/ml p=0.037,respectively). Serum levels of NSE and S100b were correlated with CHA2DS2Vasc scores (p=0.04 r=0.218 for NSE and p=0.03 r=0.229 for s100b).

Conclussıon Measurement of these markers may have an additive effect when evaluating patients’ individual risk of stroke in the setting of NVAF.