Recent studies have reported that a novel cardiac biomarker, heart-type fatty acid-binding protein (h-FABP), significantly predicts mortality inpatients with pulmonary embolism (PE) at intermediate risk. The aim of this study was to evaluate the effect of thrombolytic therapy on prognosis of the intermediate risk acute PE patients with elevated levels of h-FABP. This is non-interventional, prospective, and single-center cohort study where 80 patients (mean age 62 ± 17 years, 32 men) with confirmed acute PE were included. Only patients with PE at intermediate risk (echocardiographic signs of right ventricular overload but without evidence for hypotension or shock) were included in the study. h-FABP and other biomarkers were measured upon admission to the emergency department. Thrombolytic (Thrl) therapy was administered at the physician’s discretion. Of the included 80 patients, 24 were h-FABP positive (30 %). 14 patients (58 %) with positive h-FABP had clinical deterioration during the hospital course and required inotropic support and 12 of these patients died. However, of 56 patients with negative test, only 7 patients worsened or needed inotropic support and five patients died during the hospital stay. Mortality of patients with PE at intermediate risk was 21 %. The 30-day mortality rate was significantly higher in h-FABP(+) patients compared to h-FABP(−) patients (9 vs. 50 %, p < 0.001). Multivariate analysis revealed h-FABP as the only 30 day mortality predictor (HR 7.81, CI 1.59–38.34, p = 0.01). However, thrl therapy did dot affect the survival of these high-risk patients. Despite, h-FABP was successful to predict 30-days mortality in patients with PE at intermediate risk; it is suggested to be failed in determining the patients who will benefit from thrl therapy.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galie N, Pruszczyk P et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29(18):2276–2315
Konstantinides S, Geibel A, Olschewski M, Kasper W, Hruska N, Jackle S et al (2002) Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism. Circulation 106(10):1263–1268
Storch J, Thumser AE (2000) The fatty acid transport function of fatty acid-binding proteins. Biochim Biophys Acta 1486(1):28–44
Alhadi HA, Fox KA (2004) Do we need additional markers of myocyte necrosis: the potential value of heart fatty-acid-binding protein. QJM 97(4):187–198
Seino Y, Tomita Y, Takano T, Ohbayashi K (2004) Office cardiologists cooperative study on whole blood rapid panel tests in patients with suspicious acute myocardial infarction: comparison between heart-type fatty acid-binding protein and troponin T tests. Circ J 68(2):144–148
Kaczynska A, Pelsers MM, Bochowicz A, Kostrubiec M, Glatz JF, Pruszczyk P (2006) Plasma heart-type fatty acid binding protein is superior to troponin and myoglobin for rapid risk stratification in acute pulmonary embolism. Clin Chim Acta 371(1–2):117–123
Nakata T, Hashimoto A, Hase M, Tsuchihashi K, Shimamoto K (2003) Human heart-type fatty acid-binding protein as an early diagnostic and prognostic marker in acute coronary syndrome. Cardiology 99(2):96–104
Dellas C, Puls M, Lankeit M, Schafer K, Cuny M, Berner M et al (2010) Elevated heart-type fatty acid-binding protein levels on admission predict an adverse outcome in normotensive patients with acute pulmonary embolism. J Am Coll Cardiol 55(19):2150–2157
Boscheri A, Wunderlich C, Langer M, Schoen S, Wiedemann B, Stolte D et al (2010) Correlation of heart-type fatty acid-binding protein with mortality and echocardiographic data in patients with pulmonary embolism at intermediate risk. Am Heart J 160(2):294–300
Konstantinides S, Geibel A, Heusel G, Heinrich F, Kasper W (2002) Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 347(15):1143–1150
Agnelli G, Becattini C, Kirschstein T (2002) Thrombolysis vs heparin in the treatment of pulmonary embolism: a clinical outcome-based meta-analysis. Arch Intern Med 162(22):2537–2541
Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H et al (1989) Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 2(5):358–367
Puls M, Dellas C, Lankeit M, Olschewski M, Binder L, Geibel A et al (2007) Heart-type fatty acid-binding protein permits early risk stratification of pulmonary embolism. Eur Heart J 28(2):224–229
Niizeki T, Takeishi Y, Takabatake N, Shibata Y, Konta T, Kato T et al (2007) Circulating levels of heart-type fatty acid-binding protein in a general Japanese population: effects of age, gender, and physiologic characteristics. Circ J 71(9):1452–1457
Sharifi M, Bay C, Skrocki L, Rahimi F, Mehdipour M (2013) Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” Trial). Am J Cardiol 111(2):273–277
The urokinase pulmonary embolism trial. A national cooperative study. Circulation. 1973 47(2 Suppl):II1–II108
Goldhaber SZ, Haire WD, Feldstein ML, Miller M, Toltzis R, Smith JL et al (1993) Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 341(8844):507–511
Worster A, Smith C, Silver S, Brown MD (2007) Evidence-based emergency medicine/critically appraised topic. Thrombolytic therapy for submassive pulmonary embolism? Ann Emerg Med 50(1):78–84
Tardy B, Venet C, Zeni F, Coudrot M, Guyomarc’h S, Mismetti P (2009) Short term effect of recombinant tissue plasminogen activator in patients with hemodynamically stable acute pulmonary embolism: results of a meta-analysis involving 464 patients. Thromb Res 124(6):672–677
Becattini C, Agnelli G, Salvi A, Grifoni S, Pancaldi LG, Enea I et al (2010) Bolus tenecteplase for right ventricle dysfunction in hemodynamically stable patients with pulmonary embolism. Thromb Res 125(3):e82–e86
Fasullo S, Scalzo S, Maringhini G, Ganci F, Cannizzaro S, Basile I et al (2011) Six-month echocardiographic study in patients with submassive pulmonary embolism and right ventricle dysfunction: comparison of thrombolysis with heparin. Am J Med Sci 341(1):33–39
Goldhaber SZ, Visani L, De Rosa M (1999) Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353(9162):1386–1389
Fiumara K, Kucher N, Fanikos J, Goldhaber SZ (2006) Predictors of major hemorrhage following fibrinolysis for acute pulmonary embolism. Am J Cardiol 97(1):127–129
About this article
Cite this article
Gul, E.E., Can, I., Kayrak, M. et al. Thrombolysis in patients with pulmonary embolism and elevated heart-type fatty acid-binding protein levels. J Thromb Thrombolysis 37, 483–489 (2014). https://doi.org/10.1007/s11239-013-1008-7
- Acute pulmonary embolism