Plasma heart-type fatty acid binding protein is superior to troponin and myoglobin for rapid risk stratification in acute pulmonary embolism

• Published in: Clinica chimica acta 2006-09, Vol.371 (1), p.117-123
• Main Authors: Kaczyñska, Anna, Pelsers, Maurice M.A.L., Bochowicz, Anna, Kostrubiec, Maciej, Glatz, Jan F.C., Pruszczyk, Piotr
• Format: Article
• Language: English
• Subjects: Acute Disease; Acute pulmonary embolism; Aged; Aged, 80 and over; Biomarkers - blood; Blood Pressure; Cardiopulmonary Resuscitation; Echocardiography; Fatty Acid-Binding Proteins - blood; Heart-type fatty acid binding protein; Humans; Middle Aged; Myoglobin - blood; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Prognosis; Pulmonary Embolism - blood; Pulmonary Embolism - diagnosis; Pulmonary Embolism - mortality; Risk Assessment - methods; Risk stratification; Thrombolytic Therapy; Troponin - blood; Vasoconstrictor Agents - pharmacology
• ISSN: 0009-8981; 1873-3492
• DOI: 10.1016/j.cca.2006.02.032

Irreversible right ventricular (RV) failure with myocardial damage may precipitate fatal outcome in acute pulmonary embolism (APE). Cytoplasmic heart-type fatty acid binding protein (H-FABP) is a sensitive and specific biomarker of myocardial damage. We assessed which biomarker of myocardial damage or RV stretching is the most useful for short-term risk stratification in APE. We analyzed 77 patients (51 F, 26 M) aged 65.3 ± 16.0 years with confirmed APE. On admission, systemic blood pressure and transthoracic echocardiography (for RV overload) were recorded and plasma concentrations of myoglobin (Mb), cardiac troponin T (cTnT), N-terminal fragment of proBNP (NT-proBNP) and H-FABP were evaluated. Fifteen (19.5%) patients died and 24 (31.2%) experienced complicated clinical course (CCC)-death/thrombolysis/cardiopulmonary resuscitation/intravenous vasopressors. Hazard ratio analysis demonstrated that plasma H-FABP, Mb, cTnT and NT-proBNP concentrations predicted fatal outcome. When only APE-related deaths were considered, plasma H-FABP concentrations indicated fatal outcome. Multivariate hazard ratio analysis revealed H-FABP as the only 30-day mortality predictor (HR 1.02 CI 95% 1.01–1.05). H-FABP measured on admission is useful for short-term risk stratification in APE. It appears to be superior to cTnT, NT-proBNP and Mb in the prediction of 30-day APE-related mortality.