The use of human heart-type fatty acid-binding protein as an early diagnostic biochemical marker of myocardial necrosis in patients with acute coronary syndrome, and its comparison with troponin-T and creatine kinase–myocardial band
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Heart-type fatty acid-binding protein (H-FABP), a new biochemical marker of sarcolemmal injury due to acute myocardial ischemia, can be used as a tool in early diagnosis and management of patients at high risk. The aim of this study was to determine the early diagnostic value of H-FABP in acute coronary syndrome (within 6–24 h of chest pain) and to compare it with troponin-T (TnT) and creatine kinase–myocardial band (CK-MB) for accuracy. The study consisted of 40 consecutive patients with chest pain admitted to the coronary care unit with the diagnosis of suspected acute coronary syndrome. The patient population consisted of two groups according to the time of admission; the first group (26 patients) included patients admitted within 6 h of chest pain, and the second group (14 patients) included patients admitted within 6–24 h of chest pain. The blood samples for H-FABP, TnT, and CK-MB were obtained at admittance, at the 6th, and at the 24th hours for the first group, and at admittance and at the 24th hours for the second. Statistical analysis was performed among the 26 patients for the first 6 h values, and among all 40 patients for the values obtained within 6–24 h and at the 24th hour. The patients were then divided into groups according to the changes in the electrocardiogram (ECG) and cardiac enzymes as unstable angina pectoris, non-ST elevation myocardial infarction (MI), and ST-elevation MI. Coronary angiography was performed in 38 (95%) patients. Sensitivity of TnT, CK-MB, and H-FABP in the first group (within 6 h of chest pain) were 38%, 76%, and 95% respectively. The sensitivity of H-FABP was significantly higher than TnT (P = 0.014). Sensitivity of TnT, CK-MB, and H-FABP tests in the second time period (within 6–24 h of chest pain) were 100%, 90%, and 91% respectively. In this time period, the sensitivity of TnT was higher than H-FABP, but it was statistically insignificant. At the 24th hour, sensitivity of TnT was 100%, CK-MB 90%, and H-FABP 27.3%, and TnT and CK-MB were more sensitive than H-FABP for the whole group (P = 0.002). In the first group (within 6 h of chest pain) H-FABP positivity was slightly but insignificantly higher in patients with two- and three-vessel disease compared with those with one-vessel disease (60.7% and 33.3%, P = 0.19) and in the same group, patients who underwent primary coronary intervention had a significantly higher H-FABP positivity than others (80%, 32%, P = 0.02). Within 6–24 h of chest pain, H-FABP positivity was 80% in patients with one-vessel disease and 71.4% in patients with two- and three-vessel disease (P = 0.69). Within 6–24 h, positivity of H-FABP reached a peak value of 100% in patients who underwent primary coronary intervention, while H-FABP was positive in 60% of the others (P < 0.001). We conclude that within the 6 h of acute coronary syndrome, H-FABP seems to be a more sensitive biochemical marker than TnT in the early detection of ischemic myocardial necrosis. But after the first 6 h of the onset of chest pain the sensitivity of H-FABP decreases, and this marker should not be used alone in patients admitted 24 h after the onset of chest pain.
Key wordsAcute coronary syndrome Biochemical marker Risk stratification Heart-type fatty acid-binding protein
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- 9.Van Nieuwenhaven, FA, Kleine, AH, Wadzig, KWH 1995Discrimination between myocardial and skeletal muscle injury by assessment of the plasma ratio of myoglobin over fatty acid binding proteinCirculation9228482854Google Scholar
- 11.Okamoto, F, Sohmiya, K, Ohkaru, Y, Kawamura, K, Asayama, K, Kimura, H, Nishimura, S, Ishii, H, Sunahara, N, Tanaka, T 2000Human heart-type cytoplasmic fatty acid-binding protein (H-FABP) for the diagnosis of acute myocardial infarction. Clinical evaluation of H-FABP in comparison with myoglobin and creatine kinase isoenzyme MBClin Chem Lab Med38231238CrossRefPubMedGoogle Scholar
- 12.Braunwald, E, Antman, EM, Beasley, JW, Califf, RM, Cheitlin, MD, Hochman, JS, Jones, RH, Kereiakes, D, Kupersmith, J, Levin, TN, Pepine, CJ, Schaeffer, JW, Smith, EE,3rd, Steward, DE, Theroux, P, Alpert, JS, Eagle, KA, Faxon, DP, Fuster, V, Gardner, TJ, Gregoratos, G, Russell, RO, Smith, SC,Jr 2000ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina)J Am Coll Cardiol369701062CrossRefPubMedGoogle Scholar
- 19.Farkouh, ME, Smars, PA, Reeder, GS, Zinsmeister, AR, Evans, RW, Meloy, TD, Kopecky, SL, Allen, M, Allison, TG, Gibbons, RJ, Gabriel, SE 1998A clinical trial of a chest-pain observation unit for patients with unstable angina: Chest Pain Evaluation in the Emergency Room (CHEER) InvestigatorsN Engl J Med33918821888CrossRefPubMedGoogle Scholar
- 21.Antman, EM, Braunwald, E 2005ST-elevation myocardial infarction: pathology, pathophysiology, and clinical featuresZipes, DPLibby, PBonow, ROBraunwald, E eds. Braunwald's heart diseaseElsevier USAPhiladephia1160Google Scholar
- 22.Seino, Y, Ogata, K, Takano, T, Ishii, J, Hishida, H, Morita, H, Takeshita, H, Takagi, Y, Sugiyama, H, Tanaka, T, Kitaura, Y 2003Use of a whole blood rapid panel test for heart-type fatty acid-binding protein in patients with acute chest pain: comparison with rapid troponin T and myoglobin testsAm J Med115185190CrossRefPubMedGoogle Scholar
- 23.Katrukha, A, Bereznikova, A, Filatov, V, Esakova, T 1999Improved detection of minor ischemic cardiac injury in patients with unstable angina by measurement of Tn I and FABPClin Chem45A139Google Scholar