Clinical study of heart-type fatty acid binding protein for risk stratification and prognosis assessment of early cardiac troponin T-negative acute coronary syndrome patients

Abstract

Objective To examine the practical value of early detection of heart-type fatty acid binding protein(H-FABP)for risk stratification and prognosis assessment in cardiac troponin T(cTnT)-negative acute coronary syndrome(ACS)patients. Methods From March 2010 to March 2012, 55 patients with chest pain and negative cTnT were selected from 232 ACS patients at the General Hospital of PLA.Expression levels of cTnT and H-FABP were detected within 6 h of the onset of clinical symptoms.H-FABP and cTnT values at 12, 24, and 48 h from the onset of clinical symptoms were continuously measured to monitor the dynamic changes.Based on prognosis, patients were divided into two groups, levels of H-FABP were compared, and its predictive value for prognosis was assessed with the ROC curve. Results Within 6 h of the onset of clinical symptoms, cTnT levels in cTnT-negative ACS patients increased gradually as disease progressed and reached the peak value at 12 h before decreasing slowly and arriving at 50% of the peak value at 48 h. Meanwhile, H-FABP levels reached the peak within 6 h, decreased slightly(12.8%)at 12 h, and then decreased rapidly at 48 h(about 79%). Of 55 patients, 24 had acute myocardial infarction during hospitalization.The H-FABP level within 6 h was a good predictor for cTnT-negative ACS patients.The area under ROC curve was 0.946 and the cutoff value was 15.47 μg/L.The prediction sensitivity was 87.5%, with a specificity of 90.3%.Eleven patients had cardiovascular events after a 12-month follow-up.Levels of H-FABP were different in patients with or without cardiovascular events, [(38.08±8.43)μg/L vs.(18.96±2.85)μg/L(t=2.438, P<0.05)]. ROC curve analysis showed that the area under the curve was 0.772 and the prediction cutoff value was 44.71 μg/L.The rates of cardiovascular events were markedly different between patients with high(≥44.71 μg/L)and those with low(<44.71 μg/L)H-FABP levels(54.5% vs.11.4%). Conclusions For ACS patients with negative cTnT, H-FABP is a good index for early risk stratification and prognosis assessment. Key words: Fatty acid-binding proteins; Troponin T; Acute coronary syndrome; Prognosis