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. 2010 Apr;10(1):41-9.
Epub 2010 Apr 17.

Heart-Type Fatty Acid-Binding Protein in the Early Diagnosis of Acute Myocardial Infarction: The potential for influencing patient management

Hafidh A Alhadi  1 , Keith A A Fox
Affiliations

Heart-Type Fatty Acid-Binding Protein in the Early Diagnosis of Acute Myocardial Infarction: The potential for influencing patient management

Hafidh A Alhadi et al. Sultan Qaboos Univ Med J. 2010 Apr.

Abstract

Objectives: The objective of this study was to evaluate the diagnostic value of heart-type fatty acid-binding protein (H-FABP) in patients with acute chest pain and compare it with standard cardiac markers.

Methods: We undertook a prospective evaluation of 100 consecutive patients admitted with acute chest pain suggestive of acute coronary syndromes (ACS). Serum cardiac troponin I (cTnI), cardiac troponin T (cTnT), creatine kinase-MB (CK-MB) mass, myoglobin, and H-FABP were determined at presentation and 2, 4, 8-10, and 16-24 hours after presentation. The main outcome measure was the best sensitivity value within 6 hours after symptom onset.

Results: H-FABP peak concentration occurred at 8 hours after symptoms onset and was the most sensitive early marker with 79.9% and 98% of patients with AMI identified at presentation and 2 hours after presentation respectively. The sensitivity of all other cardiac markers (CK-MB mass, cTnI, cTnT, and myoglobin) at presentation was < 62%. The negative predictive value of H-FABP (94%) was also superior to other markers within the first 2 hours of presentation. Myoglobin was the second most sensitive early marker at presentation. Peak sensitivity of cTnI, CK-MB mass, and cTnT were present at 4, 8-10, and 8-10 hours respectively after presentation.

Conclusion: Combined measurement of H-FABP and cTnI on two occasions during the first 8 hours after symptom onset was sufficiently sensitive and specific for the early diagnosis of most patients with acute MI and may provide advantages over other cardiac marker combinations.

Keywords: Acute coronary syndromes; Acute myocardial infarction; Cardiac markers; Heart-type fatty acid-binding protein.

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Figures

Figures 1A and B
Figures 1A and B
Receiver operator characteristic (ROC) curves that were used to derive the cut-off concentrations for A) the various cardiac markers (blue = CK-MB mass concentrations; green = cTnI concentrations; red = cTnT concentrations; black = myoglobin concentrations); and B) H-FABP. See text for sensitivity and specificity values.
Figure 2
Figure 2
Illustrates the release pattern (time-concentration profile) of the different cardiac markers at each time after presentation in patients in the various study groups. The data for cTnT were omitted from the graph because they were on a different scale, but were similar to those of cardiac troponin I. Legend: CK-MB = creatine kinase-muscle & brain; cTnI = serum cardiac troponin I; H-FABP = heart-type fatty acid-binding protein
Figure 3
Figure 3
Line chart representation of the sensitivity values. Each mark represents the percentage sensitivity of the cardiac marker at that time interval Legend: CK-MB = creatine kinase-muscle & brain; cTnI = serum cardiac troponin I; cTnT = serum cardiac troponin T; H-FABP = heart-type fatty acid-binding protein
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