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Unbound Free Fatty Acids and Heart-Type Fatty Acid–Binding Protein: Diagnostic Assays and Clinical Applications

¹ Department of Chemistry and Science & Technology Research Center, School of Science and Engineering, The American University in Cairo, Cairo, Egypt.
² Department of Molecular Genetics, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
³ Departments of Pathology and Medical & Research Technology, University of Maryland School of Medicine, Baltimore, MD.

^aAddress correspondence to this author at: Department of Chemistry, The American University in Cairo, 113 Kasr El-Aini Street, Cairo 11511, Egypt. Fax 2-02-795-7565; e-mail hazzazy{at}aucegypt.edu.

Abstract

Background: A biomarker that reliably detects myocardial ischemia in the absence of necrosis would be useful for initial identification of unstable angina patients and for differentiating patients with chest pain of an etiology other than coronary ischemia, and could provide clinical utility complementary to that of cardiac troponins, the established markers of necrosis. Unbound free fatty acids (FFA_u) and their intracellular binding protein, heart-type fatty acid–binding protein (H-FABP), have been suggested to have clinical utility as indicators of cardiac ischemia and necrosis, respectively.

Methods: We examined results of clinical assessments of FFA_u and H-FABP as biomarkers of cardiac ischemia and necrosis. Data published on FFA_u and H-FABP over the past 30 years were used as the basis for this review.

Results: Although little clinical work has been done on FFA_u since the initial reports, recent studies documented an association between increased serum FFAs and ventricular dysrhythmias and death in patients with acute myocardial infarction (AMI). Recent data suggest that serum FFA_u concentrations increase well before markers of cardiac necrosis and are sensitive indicators of ischemia in AMI. H-FABP is abundant in cardiac muscle and is presumed to be involved in myocardial lipid homeostasis. Similar to myoglobin, plasma H-FABP increases within 3 h after AMI and returns to reference values within 12–24 h.

Conclusions: FFA_u may have a potential role in identifying patients with cardiac ischemia. H-FABP is useful for detecting cardiac injury in acute coronary syndromes and predicting recurrent cardiac events in acute coronary syndromes and in congestive heart failure patients. Assays are available for both markers that could facilitate further clinical investigations to assess their possible roles as markers of cardiac ischemia and/or necrosis.

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