Heart-type fatty acid-binding protein (H-FABP) as an early diagnostic biomarker in patients with acute chest pain

• Published in: Indian heart journal 2015-11, Vol.67 (6), p.538-542
• Main Authors: Vupputuri, Anjith, Sekhar, Saritha, Krishnan, Sajitha, Venugopal, K, Natarajan, K.U
• Format: Article
• Language: English
• Subjects: Acute MI; Acute Pain - blood; Acute Pain - diagnosis; Acute Pain - etiology; Biochemical marker; Biomarkers - blood; Cardiovascular; Chest pain; Chest Pain - blood; Chest Pain - diagnosis; Chest Pain - etiology; Early Diagnosis; Fatty Acid Binding Protein 3; Fatty Acid-Binding Proteins - biosynthesis; Female; Follow-Up Studies; Heart-type fatty acid-binding protein; Humans; Incidence; India - epidemiology; Male; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Myocardial Infarction - epidemiology; Original; Prospective Studies; ROC Curve; Time Factors
• ISSN: 0019-4832
• DOI: 10.1016/j.ihj.2015.06.035

Abstract Background Heart-type fatty acid-binding protein (H-FABP) is an emerging biomarker, which was found to be sensitive for the early diagnosis of acute myocardial infarction (AMI). We prospectively investigated the usefulness of H-FABP determination for the evaluation of acute chest pain in patients arriving at the emergency department. Methods Fifty-four patients presenting with acute ischemic chest pain were evaluated. H-FABP was estimated at admission using latex-enhanced immunoturbidimetric assay. Serial cardiac troponin I (cTnI), creatinine kinase-MB (CK-MB) determination, ischemia workup with stress testing, and/or coronary angiogram (CAG) were performed according to standard protocols. Results The sensitivity and specificity of H-FABP was 89.7% and 68%, for cTnI it was 62.1% and 100%, and for CK-MB it was 44.8% and 92%, respectively for diagnosis of AMI. The sensitivity of H-FABP was found to be far superior to initial cTnI and CK-MB, for those seen within 6 h (100% vs. 46.1%, 33% respectively). On further evaluation of patients with positive H-FABP and negative cTnI, 71.4% of the patients had significant lesion on CAG, indicating ischemic cause of H-FABP elevation. Six patients with normal cTnI and CK-MB with high H-FABP had ST elevation on subsequent ECGs and were taken for primary angioplasty. Conclusion H-FABP is a highly sensitive biomarker for the early diagnosis of AMI. H-FABP as early marker and cTnI as late marker would be the ideal combination to cover the complete diagnostic window for AMI. Detection of myocardial injury by H-FABP may also be applied in patients with unstable angina. H-FABP can also be used as a marker for early detection of STEMI before the ECG changes become apparent.