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Proteomics and Protein Markers |
1 Division of Critical Care, Fujita Health University Graduate School of Health Sciences, Toyoake, Japan.
2 Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
3 Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University Hospital, Toyoake, Japan.
aAddress correspondence to this author at: Division of Critical Care, Fujita Health University Graduate School of Health Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan. Fax 81-562-93-2315; e-mail jishii{at}fujita-hu.ac.jp.
Background: Heart-type fatty acid–binding protein (H-FABP) is proposed as an early biomarker for acute myocardial infarction (AMI), but its prognostic value is unclear in acute coronary syndrome (ACS). We evaluated the prognostic value of the H-FABP concentration relative to cardiac troponin T (cTnT) in the early hours of ACS.
Methods: Serum concentrations of H-FABP and cTnT were measured on admission in 328 consecutive patients hospitalized for ACS within 6 h after the onset of chest pain [AMI, 241 (73.5%) patients; ST-segment elevation myocardial infarction, 154 (47.0%) patients; and emergent coronary angiography within 24 h after admission, 287 (87.5%) patients]. Cardiac events, which were defined as cardiac death or subsequent nonfatal AMI, were monitored for 6 months after admission.
Results: During the 6-month follow-up period, there were 25 cardiac events, including 15 cardiac deaths and 10 subsequent nonfatal AMIs. Stepwise multivariate analyses including clinical, electrocardiographic, and biochemical variables revealed that increased H-FABP (above the median of 9.8 µg/L), but not increased cTnT (above the median of 0.02 µg/L), was independently associated with cardiac events in all patients [relative risk (RR) = 8.96; P = 0.0004], the subgroup of patients with ST-segment elevation myocardial infarction (RR = 11.3; P = 0.02), and the subgroup of patients with unstable angina and non-ST-segment elevation myocardial infarction (RR = 8.31; P = 0.007). The area under the ROC curve was higher for H-FABP than for cTnT (0.711 vs 0.578; P = 0.08), suggesting that H-FABP concentrations have a greater predictive capacity for cardiac events than cTnT.
Conclusion: Serum H-FABP is a potential independent predictor of cardiac events within 6 months of patient admission and may provide prognostic information superior to cTnT in the early hours of ACS.
The following articles in journals at HighWire Press have cited this article:
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  D P Bathia, D R Carless, K Viswanathan, A S Hall, and J H Barth Serum 99th centile values for two heart-type fatty acid binding protein assays Ann Clin Biochem, November 1, 2009; 46(6): 464 - 467. [Abstract] [Full Text] [PDF]
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 M. Lankeit, C. Dellas, A. Panzenbock, N. Skoro-Sajer, D. Bonderman, M. Olschewski, K. Schafer, M. Puls, S. Konstantinides, and I. M. Lang Heart-type fatty acid-binding protein for risk assessment of chronic thromboembolic pulmonary hypertension Eur. Respir. J., May 1, 2008; 31(5): 1024 - 1029. [Abstract] [Full Text] [PDF]
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 J. A. de Lemos and M. O'Donoghue The Skinny on Fatty Acid-Binding Protein J. Am. Coll. Cardiol., November 20, 2007; 50(21): 2068 - 2070. [Full Text] [PDF]
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N. Kilcullen, K. Viswanathan, R. Das, C. Morrell, A. Farrin, J. H. Barth, A. S. Hall, and for the EMMACE-2 Investigators Heart-Type Fatty Acid-Binding Protein Predicts Long-Term Mortality After Acute Coronary Syndrome and Identifies High-Risk Patients Across the Range of Troponin Values J. Am. Coll. Cardiol., November 20, 2007; 50(21): 2061 - 2067. [Abstract] [Full Text] [PDF]
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 M. Puls, C. Dellas, M. Lankeit, M. Olschewski, L. Binder, A. Geibel, C. Reiner, K. Schafer, G. Hasenfuss, and S. Konstantinides Heart-type fatty acid-binding protein permits early risk stratification of pulmonary embolism Eur. Heart J., January 2, 2007; 28(2): 224 - 229. [Abstract] [Full Text] [PDF]
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 M. O'Donoghue, J. A. de Lemos, D. A. Morrow, S. A. Murphy, J. L. Buros, C. P. Cannon, and M. S. Sabatine Prognostic Utility of Heart-Type Fatty Acid Binding Protein in Patients With Acute Coronary Syndromes Circulation, August 8, 2006; 114(6): 550 - 557. [Abstract] [Full Text] [PDF]
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