Elevated FGF-23 predicts reduced LAAev and stroke risk in patients with atrial fibrillation

Announcing a new article publication for Cardiovascular Innovations and Applications journal. Current AF management guidelines have introduced the CARE treatment model to strengthen management strategies; in this acronym, the "A" indicates anticoagulation therapy. However, despite anticoagulation, approximately one-third of patients with AF experience ischemic stroke, which is closely associated with factors such as poor adherence to anticoagulation, inappropriate anticoagulant dosing, and reduced LAAev. Therefore, patients with reduced LAAev should be closely monitored and, when necessary, LAA excision or closure should be considered to decrease residual thrombotic risk.

Although TEE can accurately measure LAAev, its high technical requirements and potential esophageal injury limit its widespread use in routine examinations of patients with AF. Therefore, using non-invasive methods to predict LAAev and identify patients with reduced LAAev might help avoid TEE overuse, and minimize patient discomfort and related complications, thereby contributing to the prevention of cardioembolic stroke and improving the prognosis of patients with AF.

The authors of this article identified FGF-23 as a novel biomarker for impaired left atrial mechanical function. On this basis, they developed a new model to predict reduced LAAev. Clinically, integrating FGF-23 into risk-stratification might improve personalized management. The authors nomogram outperformed the CHA₂DS₂-VA score, thus suggesting FGF-23 can complement traditional scores. Additionally, in areas with limited TEE access, their biomarker-based model might provide a practical triage solution. Moreover, the model enables dynamic monitoring of patients' LAAev reduction risk. For high-risk cases, TEE may be used for further assessment, and if needed, LAA excision or closure may be considered.

In conclusion, elevated FGF-23 levels were found to independently predict reduced LAAev in patients with AF. The developed nomogram integrating FGF-23, AF chronicity, and CHF status provides a practical tool for identifying high-risk individuals, and potentially guiding personalized thromboprophylaxis strategies to mitigate stroke risk.