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Biomarkers of Myocardial Cell Damage: Heart-Type Fatty Acid Binding Protein (H-FABP) for the Early Evaluation of Suspected Acute Coronary Syndrome

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Book cover Biomarkers in Cardiovascular Disease

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Abstract

Suspected acute coronary syndrome (ACS) represents a substantial healthcare problem and is responsible for a large proportion of emergency department admissions. Better triaging of patients with suspected ACS is needed to facilitate early initiation of appropriate therapy in patients with acute myocardial infarction and to exclude low-risk patients who can safely be sent home thereby limiting healthcare costs. Heart-type fatty acid-binding protein (H-FABP) is established to be the earliest available plasma marker for myocardial injury. In this chapter, the clinical utility of H-FABP for suspected ACS is evaluated. H-FABP shows added value in addition to cardiac troponin, especially in the early hours after onset of symptoms. Moreover, H-FABP identifies patients at increased risk for future cardiac events. It is concluded that measuring H-FABP along with troponin shortly after onset of symptoms improves risk stratification of patients suspected of having ACS in a cost-effective manner.

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Abbreviations

ACS:

Acute coronary syndrome

AUC:

Area under curve

CABG:

Coronary artery bypass grafting

CI:

Confidence interval

CK:

Creatine kinase

CK-MB:

Creatine kinase MB

cTn:

Cardiac-specific troponin

cTnI:

Cardiac-specific troponin I

cTnT:

Cardiac-specific troponin T

CV:

Coefficient of variance

ECG:

Electrocardiogram

GP:

General practitioner

h:

Hour

H-FABP:

Heart-type fatty acid-binding protein

hs-cTn:

High-sensitive cardiac-specific troponin

hs-cTnI:

High-sensitive cardiac-specific troponin I

hs-cTnT:

High-sensitive cardiac-specific troponin T

MI:

Myocardial infarction

NPV:

Negative predictive value

NT-proBNP:

N-terminal B-type natriuretic peptide

PoC:

Point of care

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

UAP:

Unstable angina pectoris

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Acknowledgments

Jan Glatz is currently the CSO of FABPulous BV.

Geert-Jan Dinant and Robert Willemsen are currently involved in research independently supported by a grant from FABPulous BV.

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Authors and Affiliations

  1. Department Family Medicine, Maastricht University, 616, 6200 MD, Maastricht, The Netherlands

    Robert T. A. Willemsen & Geert Jan Dinant

  2. Department of Genetics and Cell Biology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 616, 6200 MD, Maastricht, The Netherlands

    Jan F. C. Glatz

Authors
  1. Robert T. A. Willemsen
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  2. Geert Jan Dinant
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  3. Jan F. C. Glatz
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Corresponding author

Correspondence to Robert T. A. Willemsen .

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Editors and Affiliations

  1. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

  2. Sciences Division, King's College, London, United Kingdom

    Victor R. Preedy

Definitions

Acute coronary syndrome

Clinical description of complaints suspicious for a cardiac ischemic cause. Those are new or worsened complaints when compared to an earlier, stable phase. To distinguish between acute coronary syndrome and other cardiac or noncardiac causes, plasma troponin measurement is necessary unless ST elevations on ECG are seen. In case of a confirmed acute coronary syndrome, unstable angina or myocardial infarction is present.

Angina pectoris

Chest pain due to diminished blood flow in one or more coronary arteries. Stable angina pectoris: “predictable” chest pain occurring at a certain degree of exercise for a long time, due to myocardial ischemia caused by stable stenosis in a coronary artery without local thrombotic activity. Collateral circulation often compensates for diminished perfusion through the affected coronary artery. Stable angina is usually treated with medication, aiming at reduction of complaints as well as secondary prevention of cardiovascular disease. Invasive intervention is sometimes indicated when severe complaints or increased mortality risks are present. Unstable angina pectoris: chest pain of new onset or chest pain occurring at lower intensities of exercise than in the recent past, mostly due to acute plaque rupture in a coronary artery, activating local thrombotic activity. Unstable angina pectoris is a clinical diagnosis; myocardial ischemia is present, but plasma troponin levels remain normal. Condition is usually treated with invasive intervention that may be necessary on a short term.

Biomarkers of myocardial cell damage

Any molecule that is released into the circulation following myocardial cell damage and becomes measurable in peripheral blood; troponin and heart-type fatty acid-binding protein are examples of such biomarkers.

Chest pain

Pain in (ventral and/or lateral and/or dorsal) thoracic region of any cause. Among possible causes are gastroesophageal causes, thoracic wall pain, and angina pectoris.

Diagnostic accuracy

Term used for the overall capacity of a test to play a role in the diagnostic process. Accuracy in this context is a collective term for specificity, sensitivity, and positive and negative predictive value.

Myocardial infarction

(Near-)complete occlusion of a coronary artery, most often caused by plaque rupture and local thrombotic activity in consequence. Myocardial damage is present; troponin is released from the damaged myocardial cells. ST elevations on ECG can be present or absent. Usually treated with urgent percutaneous coronary intervention or bypass surgery. Prognosis: depends on magnitude of myocardial cell loss.

Point-of-care test

Test device able to measure one or more laboratory parameters and to deliver a result within a limited period of time. Result is known within the time of consultation of the patient; transport of patient material to externally located laboratory facilities is unnecessary. In a broader perspective, any test that delivers immediate results can be regarded as point-of-care test, for example, devices to measure temperature of blood pressure.

Primary care, general practice, and family medicine

Synonyms used to describe the field of medicine where no limitation on type of complaints and disease is maintained. No thresholds for care are established. Attention to a broad patient perspective (somatic, psychological, social context) is a main goal in primary goal.

Reliability

Other than diagnostic accuracy, this term describes the test ability to measure accurately and in a reproductive manner, without regarding the diagnostic potency when used in a clinical perspective.

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© 2015 Springer Science+Business Media Dordrecht

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Willemsen, R.T.A., Dinant, G.J., Glatz, J.F.C. (2015). Biomarkers of Myocardial Cell Damage: Heart-Type Fatty Acid Binding Protein (H-FABP) for the Early Evaluation of Suspected Acute Coronary Syndrome. In: Patel, V., Preedy, V. (eds) Biomarkers in Cardiovascular Disease. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7741-5_43-1

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  • DOI: https://doi.org/10.1007/978-94-007-7741-5_43-1

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  • Publisher Name: Springer, Dordrecht

  • Online ISBN: 978-94-007-7741-5

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