Diagnostic and prognostic value of heart-type fatty acid-binding protein in the early hours of acute myocardial infarction

• Published in: Acta Cardiologica Vol. 66; no. 3; pp. 315 - 321
• Main Authors: Garcia-Valdecasas, Sonsoles, Ruiz-Alvarez, Maria J., Garcia De Tena, Jaime, De Pablo, Raul, Huerta, Isabel, Barrionuevo, Marta, Coca, Carmen, Arribas, Ignacio
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01-06-2011
• Subjects: Aged; Aged, 80 and over; CK-MB; Fatty Acid Binding Protein 3; Fatty Acid-Binding Proteins - blood; Female; H-FABP; Humans; Male; Middle Aged; Myocardial Infarction - diagnosis; myoglobin; Prognosis; Proportional Hazards Models; Prospective Studies; ROC Curve; Sensitivity and Specificity; troponin; Troponin I - blood
• ISSN: 0001-5385; 1784-973X; 0373-7934
• DOI: 10.1080/AC.66.3.2114131

Background Heart-type fatty acid-binding protein (H-FABP) is a cytosolic protein that is released into the bloodstream when the myocardium is injured. The aim was to determine the diagnostic and prognostic value of H-FABP in patients with suspected acute myocardial infarction (AMI) within the fi rst 3-6 hours after the onset of chest pain.
Methods and results A consecutive series of 165 patients with chest pain lasting less than 6 hours were enrolled in a forward observational design in the emergency department. The diagnostic validity of H-FABP was evaluated according to sensitivity, specifi city, and predictive values, likelihood ratios, ROC curves, and multivariate logistic regression analyses. The prognostic value of H-FABP at 6 months was checked using survival curves and the multivariate Cox proportional hazards model.
The sensitivity of H-FABP was 81% (95% CI: 69.2-92.9). Its area under the ROC curve: 0.729 (95% CI: 0.63-0.83) and negative likelihood ratio (0.38; 95% CI: 0.22-0.65) were signifi cantly better than both troponin (cTnI) and CK-MB, whereas its specifi city, 53% (95% CI: 41.1-64.8), was lower than that of the other markers. Increased H-FABP added diagnostic information as it demonstrated independent association with AMI by logistic regression analysis.
Increased H-FABP and cTnI were both strong and independent predictors of outcome in the 6-month follow-up (hazard ratio: 2.18; 95% CI: 1.07-4.42; and 2.34; 95% CI: 0.98-5.59, respectively).
Conclusions H-FABP is, within 6 hours and also within 3 hours, more sensitive than the other markers in the early diagnosis of AMI and it is an independent prediction factor of events within 6 months.