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. 2018 Aug:58:53-59.
doi: 10.1016/j.clinbiochem.2018.05.006. Epub 2018 May 8.

The potential role of a turbidimetric heart-type fatty acid-binding protein assay to aid in the interpretation of persistently elevated, non-changing, cardiac troponin I concentrations

Peter A Kavsak  1 , Craig Ainsworth  2 , Donald M Arnold  3 , Terry Scott  4 , Lorna Clark  4 , Josko Ivica  5 , Katharine Mackett  5 , Richard Whitlock  6 , Andrew Worster  7
Affiliations

The potential role of a turbidimetric heart-type fatty acid-binding protein assay to aid in the interpretation of persistently elevated, non-changing, cardiac troponin I concentrations

Peter A Kavsak et al. Clin Biochem. 2018 Aug.

Abstract

Background: Elevated and non-changing high-sensitivity cardiac troponin (hs-cTn) concentrations may suggest a process other than acute injury, possibly due to chronic condition(s) causing the elevation, an analytical error/interference or the formation of macrocomplexes. Heart-type fatty acid binding protein (H-FABP) might be useful in this setting to identify the etiology of abnormally high and non-changing cTn concentrations which could aid clinical decision making in the hospital setting.

Methods: We analytically validated the H-FABP assay (Randox) on the Abbott ARICHTECTc8000 platform, testing imprecision, linearity, stability, and matrix comparison. Over the 2-month analytical validation; EDTA plasma samples from patients with a hospital visit with persistently elevated and stable cTnI concentrations (Abbott hs-cTnI≥52 ng/L or 2x99th percentile upper limit of normal (ULN = 26 ng/L) with change between results <20%) were collected and frozen (-20 °C). These samples were tested with the H-FABP assay, polyethylene glycol (PEG) precipitation, with the lowest estimated glomerular filtration rate (eGRF) during the hospital visit also obtained from these patients.

Results: The H-FABP assay was linear, with concentrations stable after 4 freeze/thaw cycles, up to 150 h at room temperature, and comparable between lithium heparin and EDTA plasma. During the validation there were 6 patients with eGFR ≥60 ml/min/1.73m2 identified (total population screened n = 917) with high and non-changing hs-cTnI concentrations. All 6 patients had H-FABP<2xULN; with 3 patients having a macrocomplex and a final diagnosis of not ACS.

Conclusion: Testing of H-FABP in patients with an eGFR≥60 ml/min/1.73m2 with persistently high and stable cTn elevations may help to confirm prior cardiac injury or the presence of macrocomplexes as the source of these elevations.

Keywords: H-FABP; High-sensitivity cardiac troponin; Macrocomplexes; Myocardial injury; Stability.

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