Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Review

Volume 17, Number 5, October 2026, pages 361-378

Conventional and Emerging Biomarkers for Predicting Post-Ablation Atrial Fibrillation Recurrence: An Updated Systematic Review

↓ Figure 2. Biomarker subgroups associated with post-ablation AF recurrence. CRP: C-reactive protein; hs-CRP: high-sensitivity C-reactive protein; HMGB1: high-mobility group box 1; TNF-α: tumor necrosis factor-α; CA-125: carbohydrate antigen-125.

↓ **Table 1.** Articles Identified Using Each Database
Database	Keywords	Search strategy	Filters	Search result
MeSH: Medical Subject Headings; PMC: PubMed Central.
Pubmed MeSH/Medline/PMC	Biomarkers, natriuretic peptides, atrial fibrillation recurrence, catheter ablation	Biomarkers OR natriuretic peptides OR "Biomarkers/analysis"[Majr] OR "Biomarkers/blood"[Majr] OR "Biomarkers/chemistry"[Majr] OR "Biomarkers/metabolism"[Majr] AND atrial fibrillation OR atrial fibrillation recurrence OR "Atrial Fibrillation/complications"[Majr] OR "Atrial Fibrillation/diagnosis"[Majr] OR "Atrial Fibrillation/diagnostic imaging"[Majr] OR "Atrial Fibrillation/drug therapy"[Majr] OR "Atrial Fibrillation/etiology"[Majr] OR "Atrial Fibrillation/pathology"[Majr] OR "Atrial Fibrillation/physiopathology"[Majr] OR "Atrial Fibrillation/prevention and control"[Majr] AND catheter ablation OR "Catheter Ablation/adverse effects"[Mesh] OR "Catheter Ablation/instrumentation"[Mesh] OR "Catheter Ablation/methods"[Mesh]	Filters applied: in the last 5 years, English, humans, exclude preprints	79
Cochrane Library	Biomarkers, natriuretic peptides, atrial fibrillation recurrence, catheter ablation	"biomarkers" AND "atrial fibrillation" AND "catheter ablation"	Last 5 years, English	15
Science Direct	Biomarkers, natriuretic peptides, atrial fibrillation recurrence, catheter ablation	"Biomarkers" AND "atrial fibrillation recurrence" AND "catheter ablation"	Last 5 years, review articles, research articles	23
Europe PubMed Central		"Biomarkers" OR "natriuretic peptides" AND "atrial fibrillation recurrence" AND "catheter ablation"	Last 5 years, full text in Europe PMC, review articles, excluding preprints, books and documents	131
Google Scholar		“(“biomarkers” OR “natriuretic peptides”)” AND “atrial fibrillation recurrence” AND “catheter ablation”	Last 5 years	475

↓ Table 1. Articles Identified Using Each Database

Database

Keywords

Search strategy

Filters

Search result

MeSH: Medical Subject Headings; PMC: PubMed Central.

Pubmed MeSH/Medline/PMC

Biomarkers, natriuretic peptides, atrial fibrillation recurrence, catheter ablation

Biomarkers OR natriuretic peptides OR "Biomarkers/analysis"[Majr] OR "Biomarkers/blood"[Majr] OR "Biomarkers/chemistry"[Majr] OR "Biomarkers/metabolism"[Majr] AND atrial fibrillation OR atrial fibrillation recurrence OR "Atrial Fibrillation/complications"[Majr] OR "Atrial Fibrillation/diagnosis"[Majr] OR "Atrial Fibrillation/diagnostic imaging"[Majr] OR "Atrial Fibrillation/drug therapy"[Majr] OR "Atrial Fibrillation/etiology"[Majr] OR "Atrial Fibrillation/pathology"[Majr] OR "Atrial Fibrillation/physiopathology"[Majr] OR "Atrial Fibrillation/prevention and control"[Majr] AND catheter ablation OR "Catheter Ablation/adverse effects"[Mesh] OR "Catheter Ablation/instrumentation"[Mesh] OR "Catheter Ablation/methods"[Mesh]

Filters applied: in the last 5 years, English, humans, exclude preprints

Cochrane Library

Biomarkers, natriuretic peptides, atrial fibrillation recurrence, catheter ablation

"biomarkers" AND "atrial fibrillation" AND "catheter ablation"

Last 5 years, English

Science Direct

Biomarkers, natriuretic peptides, atrial fibrillation recurrence, catheter ablation

"Biomarkers" AND "atrial fibrillation recurrence" AND "catheter ablation"

Last 5 years, review articles, research articles

Europe PubMed Central

"Biomarkers" OR "natriuretic peptides" AND "atrial fibrillation recurrence" AND "catheter ablation"

Last 5 years, full text in Europe PMC, review articles, excluding preprints, books and documents

131

Google Scholar

“(“biomarkers” OR “natriuretic peptides”)” AND “atrial fibrillation recurrence” AND “catheter ablation”

Last 5 years

475

↓ **Table 2.** Quality Appraisal Tools Based on Their Study Design
Quality assessment tool	Type of study	Total score	Accepted score (> 70%)	Number of accepted studies
NCOT: Newcastle–Ottawa Tool; AMSTAR 2: Assessment of Multiple Systematic Reviews 2.
NCOT¹	23 observational studies	9	7	Meyre et al 2020¹ [38], Jaroonpipatkul et al 2023² [39], Li et al 2022¹ [40], AlKassas et al 2023¹ [41], Wang et al 2021¹ [42], Chen et al 2020¹ [43], Li et al 2022¹ [44], Hennings et al 2023¹ [45], Tan et al 2021¹ [46], Wei et al 2020¹ [47], Li et al 2024² [48], Shi et al 2024² [49], El-Harasis et al 2024¹ [50], Jia et al 2024¹ [51], Tang et al 2022¹ [52], Wang et al 2024¹ [53], Gumanova et al 2024¹ [54], Sustr et al 2024¹ [55], Lage et al 2023¹ [56], Zhao et al 2024¹ [57], Meng et al 2024¹ [58], Wang et al 2022¹ [59], Kawaji et al 2023¹ [60], Zhao et al 2023¹ [61], Badoz et al 2021¹ [62], Younes et al 2023¹ [63], Yuan et al 2023² [64]
AMSTAR2²	4 systematic review/meta-analysis	16	12

↓ Table 2. Quality Appraisal Tools Based on Their Study Design

Quality assessment tool

Type of study

Total score

Accepted score (> 70%)

Number of accepted studies

NCOT: Newcastle–Ottawa Tool; AMSTAR 2: Assessment of Multiple Systematic Reviews 2.

NCOT¹

23 observational studies

Meyre et al 2020¹ [38], Jaroonpipatkul et al 2023² [39], Li et al 2022¹ [40], AlKassas et al 2023¹ [41], Wang et al 2021¹ [42], Chen et al 2020¹ [43], Li et al 2022¹ [44], Hennings et al 2023¹ [45], Tan et al 2021¹ [46], Wei et al 2020¹ [47], Li et al 2024² [48], Shi et al 2024² [49], El-Harasis et al 2024¹ [50], Jia et al 2024¹ [51], Tang et al 2022¹ [52], Wang et al 2024¹ [53], Gumanova et al 2024¹ [54], Sustr et al 2024¹ [55], Lage et al 2023¹ [56], Zhao et al 2024¹ [57], Meng et al 2024¹ [58], Wang et al 2022¹ [59], Kawaji et al 2023¹ [60], Zhao et al 2023¹ [61], Badoz et al 2021¹ [62], Younes et al 2023¹ [63], Yuan et al 2023² [64]

AMSTAR2²

4 systematic review/meta-analysis

↓ **Table 3.** Grading Criteria Used for Biomarker Reliability
Strong reliability	Moderate reliability	Weak reliability
AUC: area under the curve; HR: hazard ratio; OR: odds ratio.
Adjusted HR/OR ≥ 1.8 Statistically significant (P < 0.05) Multivariable adjustment performed AUC ≥ 0.75	Adjusted HR/OR 1.3–1.79 Statistically significant AUC 0.65–0.74 Independent predictor but moderate effect size	Only mean difference Borderline effect No multivariable adjustment AUC < 0.65 Inconsistent results

↓ Table 3. Grading Criteria Used for Biomarker Reliability

Strong reliability

Moderate reliability

Weak reliability

AUC: area under the curve; HR: hazard ratio; OR: odds ratio.

Adjusted HR/OR ≥ 1.8
Statistically significant (P < 0.05)
Multivariable adjustment performed
AUC ≥ 0.75

Adjusted HR/OR 1.3–1.79
Statistically significant
AUC 0.65–0.74
Independent predictor but moderate effect size

Only mean difference
Borderline effect
No multivariable adjustment
AUC < 0.65
Inconsistent results

↓ **Table 4.** Core Mechanistic Biomarkers of Post-Ablation AF Recurrence (Inflammatory, Remodeling, Metabolic)
Biomarker	Timing	Adjusted effect	AUC	Design	N	AF type	Follow-up methods	Strength	Reliability
CRP: C-reactive protein; hs-CRP: high-sensitivity C-reactive protein; HMGB1: high mobility group box 1; TNF-α: tumor necrosis factor-α; CA-125: plasma carbohydrate antigen-125; MHR: monocyte/high-density lipoprotein ratio; TIMP-1: tissue inhibitor of metalloproteinase-1; BMP10: bone morphogenetic protein 10; sST2: soluble suppression of tumorigenicity 2; GDF-15: growth differentiation factor 15; Hcy: homocysteine; IL-6: interleukin 6; TyG: triglyceride glucose; METS-IR: metabolic score for insulin resistance; TyG-BMI: triglyceride glucose body mass index; TG/HDL-C: triglyceride to high-density lipoprotein cholesterol; HR: hazard ratio; OR: odds ratio; AUC: area under the curve; pre: pre-ablation; post: post-ablation; WMD: weighted mean difference; SMD: standardized mean difference.
Inflammatory biomarkers
CRP [38]	Pre	aHR 1.60 (Q4); 1.21 per unit	-	Prospective	711	Paroxy AF	ECG, Holter	Moderate dose-response	Moderate
hs-CRP [39]	Post	WMD 0.09	-	Meta-analysis	789	AF	ECG, Holter	Small mean difference	Weak
HMGB1 [40]	Post	OR 5.29; HR 3.81 for AF free survival	0.68	Prospective	72	Paroxy AF	ECG, Holter	Large effect size, limited sample	Strong
TNF-α, visfatin, adiponectin [41]	Pre	β 0.28, β 0.35, β 0.30	0.67, 0.73, 0.70	Prospective	117	Paroxy/persist AF	ECG, Holter	Independent predictor	Moderate-strong
IL-6, angiopoietin-2 [50]	Pre	OR 1.02, OR 1.08	0.71, 0.71	Retrospective	1,873	Paroxy/persist AF	ECG, Holter	Independent (small effect)	Weak-moderate
CA-125 [42]	Pre	aHR 4.25 (Q4); 3.23 per unit	-	Prospective	353	AF	ECG, Holter	Large graded effect; strong dose-response	Strong
MHR [43]	Pre	OR 1.34	0.71	Retrospective	125	Paroxy AF	ECG, Holter	Moderate independent effect	Moderate
Remodeling biomarkers
TIMP-1 [44]	Pre	aHR 1.80 high vs. low	-	Prospective	194	Paroxy/persist AF	ECG, Holter	Independent/moderate effect	Moderate
BMP-10 [45]	Pre	aHR 1.98 per unit	-	Prospective	1,112	Paroxy/persist AF	ECG, Holter	Near 2-fold risk	Strong
sST2 [46]	Pre	HR 1.04 high vs. low (persistent AF)	0.75	Prospective	210	Paroxy/persist AF	ECG, Holter	Good discrimination	Moderate-strong
GDF-15 [47]	Pre	HR 1.053 (recurrent group)	-	Prospective	150	Persist AF	ECG, Holter	Modest effect	Moderate
Homocysteine [48]	Pre	OR 2.75, I² = 0% (high vs. low)	-	Meta-analysis	2,147	AF	ECG, Holter	Highly consistent, I² = 0%	Strong
sST2 [49]	Pre	SMD 1.15, I² = 92% (recurrent group)	-	Meta-analysis	1,779	AF	ECG, Holter	Significant heterogeneity	Moderate
Metabolic biomarkers
TyG index [51]	Pre	HR 2.06 (high vs. low), HR 1.58 (locus 3)	-	Retrospective	997	Paroxy/persist AF	24 ambulatory ECG	Consistent	Strong
TyG index [52]	Pre	aHR 2.02	0.74	Retrospective	275	Paroxy/persist AF	ECG, Holter	Independent	Strong
METS-IR [53]	Pre	aHR 1.82 (tertile 3), 1.04 per unit	-	Retrospective	2,242	Paroxy/persist AF	ECG, Holter	Graded risk, large sample	Moderate-strong
TyG-BMI	Pre	aHR 1.71 (tertile 3), 1.01 per unit	-					Independent	Moderate-strong
TyG index	Pre	aHR 1.25 (tertile 3), 1.18 per unit	-					Independent	Moderate
TG/HDL-C	Pre	Not significant (P > 0.05)	-					No predictive value	Not reliable

↓ Table 4. Core Mechanistic Biomarkers of Post-Ablation AF Recurrence (Inflammatory, Remodeling, Metabolic)

Biomarker

Timing

Adjusted effect

AUC

Design

AF type

Follow-up methods

Strength

Reliability

CRP: C-reactive protein; hs-CRP: high-sensitivity C-reactive protein; HMGB1: high mobility group box 1; TNF-α: tumor necrosis factor-α; CA-125: plasma carbohydrate antigen-125; MHR: monocyte/high-density lipoprotein ratio; TIMP-1: tissue inhibitor of metalloproteinase-1; BMP10: bone morphogenetic protein 10; sST2: soluble suppression of tumorigenicity 2; GDF-15: growth differentiation factor 15; Hcy: homocysteine; IL-6: interleukin 6; TyG: triglyceride glucose; METS-IR: metabolic score for insulin resistance; TyG-BMI: triglyceride glucose body mass index; TG/HDL-C: triglyceride to high-density lipoprotein cholesterol; HR: hazard ratio; OR: odds ratio; AUC: area under the curve; pre: pre-ablation; post: post-ablation; WMD: weighted mean difference; SMD: standardized mean difference.

Inflammatory biomarkers

CRP [38]

Pre

aHR 1.60 (Q4); 1.21 per unit

Prospective

711

Paroxy AF

ECG, Holter

Moderate dose-response

Moderate

hs-CRP [39]

Post

WMD 0.09

Meta-analysis

789

ECG, Holter

Small mean difference

Weak

HMGB1 [40]

Post

OR 5.29; HR 3.81 for AF free survival

0.68

Prospective

Paroxy AF

ECG, Holter

Large effect size, limited sample

Strong

TNF-α, visfatin, adiponectin [41]

Pre

β 0.28, β 0.35, β 0.30

0.67, 0.73, 0.70

Prospective

117

Paroxy/persist AF

ECG, Holter

Independent predictor

Moderate-strong

IL-6, angiopoietin-2 [50]

Pre

OR 1.02, OR 1.08

0.71, 0.71

Retrospective

1,873

Paroxy/persist AF

ECG, Holter

Independent (small effect)

Weak-moderate

CA-125 [42]

Pre

aHR 4.25 (Q4); 3.23 per unit

Prospective

353

ECG, Holter

Large graded effect; strong dose-response

Strong

MHR [43]

Pre

OR 1.34

0.71

Retrospective

125

Paroxy AF

ECG, Holter

Moderate independent effect

Moderate

Remodeling biomarkers

TIMP-1 [44]

Pre

aHR 1.80 high vs. low

Prospective

194

Paroxy/persist AF

ECG, Holter

Independent/moderate effect

Moderate

BMP-10 [45]

Pre

aHR 1.98 per unit

Prospective

1,112

Paroxy/persist AF

ECG, Holter

Near 2-fold risk

Strong

sST2 [46]

Pre

HR 1.04 high vs. low (persistent AF)

0.75

Prospective

210

Paroxy/persist AF

ECG, Holter

Good discrimination

Moderate-strong

GDF-15 [47]

Pre

HR 1.053 (recurrent group)

Prospective

150

Persist AF

ECG, Holter

Modest effect

Moderate

Homocysteine [48]

Pre

OR 2.75, I² = 0% (high vs. low)

Meta-analysis

2,147

ECG, Holter

Highly consistent, I² = 0%

Strong

sST2 [49]

Pre

SMD 1.15, I² = 92% (recurrent group)

Meta-analysis

1,779

ECG, Holter

Significant heterogeneity

Moderate

Metabolic biomarkers

TyG index [51]

Pre

HR 2.06 (high vs. low), HR 1.58 (locus 3)

Retrospective

997

Paroxy/persist AF

24 ambulatory ECG

Consistent

Strong

TyG index [52]

Pre

aHR 2.02

0.74

Retrospective

275

Paroxy/persist AF

ECG, Holter

Independent

Strong

METS-IR [53]

Pre

aHR 1.82 (tertile 3), 1.04 per unit

Retrospective

2,242

Paroxy/persist AF

ECG, Holter

Graded risk, large sample

Moderate-strong

TyG-BMI

Pre

aHR 1.71 (tertile 3), 1.01 per unit

Independent

Moderate-strong

TyG index

Pre

aHR 1.25 (tertile 3), 1.18 per unit

Independent

Moderate

TG/HDL-C

Pre

Not significant (P > 0.05)

No predictive value

Not reliable

↓ **Table 5.** Natriuretic Peptides and Other Emerging Biomarkers of Post-Ablation AF Recurrence
Biomarker	Timing	Adjusted effect	AUC	Design	N	AF type	Follow-up methods	Strength	Reliability
miR: microRNAs; TMAO: trimethylamine-N-oxide; LPS: lipopolysaccharide; BNP: B-type natriuretic peptide; NT-proBNP: N-terminal pro-B-type natriuretic peptide; MR-proANP: mid-regional N-terminal pro-atrial natriuretic; ANP: atrial natriuretic peptide; HR: hazard ratio; OR: odds ratio; AUC: area under the curve; pre: pre-ablation; post: post-ablation; SMD: standardized mean difference.
Other biomarkers
RAD51/p63 [54]	Pre	Mean difference only	-	Prospective	146	Paroxy/persist AF	ECG, Loop recorder	Mean difference only	Weak
miR-206 [55]	Pre	OR 2.65 per unit	-	Prospective	49	Paroxy/persist AF	ECG, Holter	Small sample	Moderate
miR-451a [56]	Post	-	0.72	Prospective	42	Paroxy/persit AF	ECG, Holter	Small sample, no aHR	Moderate
Corin [57]	Pre	aHR 1.46, > 494.85 pg/mL	0.68	Prospective	616	Paroxy/persist AF	ECG, Holter	Moderate discrimination	Moderate
TMAO [58]	Pre	HR 13.53 for cutoff > 4.3 µM serum level	0.84	Prospective	152	Paroxy/Persist AF	ECG, Holter	Highest discrimination	Very strong
LPS [59]	Pre	HR 5.69 Log LPS	-	Retrospective	159	AF	ECG, Holter	Large effect (wide CI)	Strong
Natriuretic peptides
BNP [60]	Pre	aHR 0.63 for lower AF risk with low BNP	-	Retrospective	1,750	Paroxy/persit AF	ECG, Holter		Moderate
NT-proBNP [61]	Pre	HR 2.89 for NT-proBNP > 168.05 pg/mL	0.68	Retrospective	326	Paroxy/persist AF	ECG, Holter	Independent	Strong
MR-proANP [62]	Pre	OR 24.27 for MRproANP > 107.9 pmol/L	-	Prospective	105	Paroxy/persit AF	ECG, Holter	Extremely large independent effect	Very strong
BNP [63]	Pre	aHR 1.85 per 100 unit	-	Retrospective	125	Persist AF	1 lead EKG smartphone device	Reproducible	Moderate-strong
ANP/BNP/MR-proANP/NT-proBNP) [64]	Pre	SMD 0.39, I² 45% for ANP, 0.51 I² 93% for BNP, 0.71 I² 84% for NT-proBNP, 0.91 I² 88% for MR-proANP	-	Meta-analysis	10,085	Paroxy/persist AF	ECG, Holter	High heterogeneity	Moderate-variable

↓ Table 5. Natriuretic Peptides and Other Emerging Biomarkers of Post-Ablation AF Recurrence

Biomarker

Timing

Adjusted effect

AUC

Design

AF type

Follow-up methods

Strength

Reliability

miR: microRNAs; TMAO: trimethylamine-N-oxide; LPS: lipopolysaccharide; BNP: B-type natriuretic peptide; NT-proBNP: N-terminal pro-B-type natriuretic peptide; MR-proANP: mid-regional N-terminal pro-atrial natriuretic; ANP: atrial natriuretic peptide; HR: hazard ratio; OR: odds ratio; AUC: area under the curve; pre: pre-ablation; post: post-ablation; SMD: standardized mean difference.

Other biomarkers

RAD51/p63 [54]

Pre

Mean difference only

Prospective

146

Paroxy/persist AF

ECG, Loop recorder

Mean difference only

Weak

miR-206 [55]

Pre

OR 2.65 per unit

Prospective

Paroxy/persist AF

ECG, Holter

Small sample

Moderate

miR-451a [56]

Post

0.72

Prospective

Paroxy/persit AF

ECG, Holter

Small sample, no aHR

Moderate

Corin [57]

Pre

aHR 1.46, > 494.85 pg/mL

0.68

Prospective

616

Paroxy/persist AF

ECG, Holter

Moderate discrimination

Moderate

TMAO [58]

Pre

HR 13.53 for cutoff > 4.3 µM serum level

0.84

Prospective

152

Paroxy/Persist AF

ECG, Holter

Highest discrimination

Very strong

LPS [59]

Pre

HR 5.69 Log LPS

Retrospective

159

ECG, Holter

Large effect (wide CI)

Strong

Natriuretic peptides

BNP [60]

Pre

aHR 0.63 for lower AF risk with low BNP

Retrospective

1,750

Paroxy/persit AF

ECG, Holter

Moderate

NT-proBNP [61]

Pre

HR 2.89 for NT-proBNP > 168.05 pg/mL

0.68

Retrospective

326

Paroxy/persist AF

ECG, Holter

Independent

Strong

MR-proANP [62]

Pre

OR 24.27 for MRproANP > 107.9 pmol/L

Prospective

105

Paroxy/persit AF

ECG, Holter

Extremely large independent effect

Very strong

BNP [63]

Pre

aHR 1.85 per 100 unit

Retrospective

125

Persist AF

1 lead EKG smartphone device

Reproducible

Moderate-strong

ANP/BNP/MR-proANP/NT-proBNP) [64]

Pre

SMD 0.39, I² 45% for ANP, 0.51 I² 93% for BNP, 0.71 I² 84% for NT-proBNP, 0.91 I² 88% for MR-proANP

Meta-analysis

10,085

Paroxy/persist AF

ECG, Holter

High heterogeneity

Moderate-variable

↓ **Table 6.** Conventional and Emerging Biomarkers Associated With AF Recurrence Post-Ablation
Emerging biomarkers for AF recurrence after catheter ablation	Conventional biomarkers for AF recurrence after catheter ablation
HMGB1, visfatin (adipocytokine), adiponectin, plasma CA-125, MHR, TIMP-1, BMP-10, sST2, GDF-15, RAD51 & p63, plasmatic microRNA-206, miRNAs/miR-451a, corin, serum Hcy, angiopoietin-2, TyG index, METS-IR, TyG-BMI, TMAO, serum LPS, TG/HDL-C ratio	CRP), hs-CRP, TNF-α, IL-6, BNP, MR-proANP, ANP), NT-proBNP

↓ Table 6. Conventional and Emerging Biomarkers Associated With AF Recurrence Post-Ablation

Emerging biomarkers for AF recurrence after catheter ablation

Conventional biomarkers for AF recurrence after catheter ablation

HMGB1, visfatin (adipocytokine), adiponectin, plasma CA-125, MHR, TIMP-1, BMP-10, sST2, GDF-15, RAD51 & p63, plasmatic microRNA-206, miRNAs/miR-451a, corin, serum Hcy, angiopoietin-2, TyG index, METS-IR, TyG-BMI, TMAO, serum LPS, TG/HDL-C ratio

CRP), hs-CRP, TNF-α, IL-6, BNP, MR-proANP, ANP), NT-proBNP

↓ **Table 7.** Structured Qualitative Assessment of Biomarker Predictive Strength and Reliability
Very strong associations	Strong associations	Moderate to moderate-strong associations	Weak associations/limited evidence
CRP: C-reactive protein; hs-CRP: high-sensitivity C-reactive protein; HMGB1: high mobility group box 1; TNF-α: tumor necrosis factor-α; CA-125: plasma carbohydrate antigen-125; MHR: monocyte/high-density lipoprotein ratio; TIMP-1: tissue inhibitor of metalloproteinase-1; BMP-10: bone morphogenetic protein 10; sST2: soluble suppression of tumorigenicity 2; GDF-15: growth differentiation factor 15; Hcy: homocysteine; IL-6: interleukin 6; TyG: triglyceride glucose; METS-IR: metabolic score for insulin resistance; TyG-BMI: triglyceride glucose body mass index; TG/HDL-C: triglyceride to high-density lipoprotein cholesterol; miR: microRNAs; TMAO: trimethylamine-N-oxide; LPS: lipopolysaccharide; BNP: B-type natriuretic peptide; NT-proBNP: N-terminal pro-B-type natriuretic peptide; MR-proANP: mid-regional N-terminal pro-atrial natriuretic; ANP: atrial natriuretic peptide; HR: hazard ratio; OR: odds ratio; AUC: area under the curve.
MR-proANP (OR 24.27) TMAO (HR 13.53, AUC 0.84) CA-125 (aHR 4.25 Q4)	HMGB1 (OR 5.29) NT-proBNP (HR 2.89) TyG Index (HR 2.06) BMP-10 (aHR 1.98) LPS (HR 5.69) BNP-elevated (aHR 1.85)	sST2 in persistent AF (HR 1.04/AUC 0.75), visfatin (β 0.35/AUC 0.73), METS-IR (aHR 1.82) TyG-BMI (aHR 1.71) TIMP-1 (aHR 1.80) Corin (aHR 1.46/AUC 0.68) MHR (OR 1.34/AUC 0.71) TNF-α (β 0.28/AUC 0.67) Adiponectin (β 0.30/AUC 0.70) Angiopoietin-2 (OR 1.08/AUC 0.71) CRP (aHR 1.60)	IL-6 (minimal OR 1.02) RAD51/p63 (mean difference only) miR-206 (small sample 49) miR-451a (small sample/no adjusted HR) GDF-15 (HR 1.05, small effect)

↓ Table 7. Structured Qualitative Assessment of Biomarker Predictive Strength and Reliability

Very strong associations

Strong associations

Moderate to moderate-strong associations

Weak associations/limited evidence

CRP: C-reactive protein; hs-CRP: high-sensitivity C-reactive protein; HMGB1: high mobility group box 1; TNF-α: tumor necrosis factor-α; CA-125: plasma carbohydrate antigen-125; MHR: monocyte/high-density lipoprotein ratio; TIMP-1: tissue inhibitor of metalloproteinase-1; BMP-10: bone morphogenetic protein 10; sST2: soluble suppression of tumorigenicity 2; GDF-15: growth differentiation factor 15; Hcy: homocysteine; IL-6: interleukin 6; TyG: triglyceride glucose; METS-IR: metabolic score for insulin resistance; TyG-BMI: triglyceride glucose body mass index; TG/HDL-C: triglyceride to high-density lipoprotein cholesterol; miR: microRNAs; TMAO: trimethylamine-N-oxide; LPS: lipopolysaccharide; BNP: B-type natriuretic peptide; NT-proBNP: N-terminal pro-B-type natriuretic peptide; MR-proANP: mid-regional N-terminal pro-atrial natriuretic; ANP: atrial natriuretic peptide; HR: hazard ratio; OR: odds ratio; AUC: area under the curve.

MR-proANP (OR 24.27)
TMAO (HR 13.53, AUC 0.84)
CA-125 (aHR 4.25 Q4)

HMGB1 (OR 5.29)
NT-proBNP (HR 2.89)
TyG Index (HR 2.06)
BMP-10 (aHR 1.98)
LPS (HR 5.69)
BNP-elevated (aHR 1.85)

sST2 in persistent AF (HR 1.04/AUC 0.75), visfatin (β 0.35/AUC 0.73), METS-IR (aHR 1.82)
TyG-BMI (aHR 1.71)
TIMP-1 (aHR 1.80)
Corin (aHR 1.46/AUC 0.68)
MHR (OR 1.34/AUC 0.71)
TNF-α (β 0.28/AUC 0.67)
Adiponectin (β 0.30/AUC 0.70)
Angiopoietin-2 (OR 1.08/AUC 0.71)
CRP (aHR 1.60)

IL-6 (minimal OR 1.02)
RAD51/p63 (mean difference only)
miR-206 (small sample 49)
miR-451a (small sample/no adjusted HR)
GDF-15 (HR 1.05, small effect)