Combination of heart-type fatty acid binding protein and QRS prolongation can risk-stratify patients with chronic heart failure

Abstract

Background: It was reported that abnormal prolongation of QRS duration is associated with cardiac prognosis in patients with chronic heart failure (CHF). QRS prolongation represents left ventricular hypertrophy, bundle brunch block, and intra ventricular conduction disturbance. We and others reported that elevated levels of heart-type fatty acid binding protein (H-FABP), which is a marker of ongoing myocardial damage, can predict poor outcomes in CHF patients. The aim of this study was to elucidate whether a combination of markers for ongoing myocardial damage and electrical disturbance can risk-stratify CHF patients. Methods and results: We measured the QRS duration and serum H-FABP levels in 348 consecutive CHF patients at admission. Patients were prospectively followed during a median follow up period of 520 days. There were 132 cardiac events, including 28 cardiac deaths and 104 re-hospitalizations for worsening heart failure. Cut off value for H-FABP levels was determined from median value (4.7 ng/ml). All patients were stratified into 4 groups according to serum H-FABP level and QRS duration (≥120 ms). Multivariate analysis demonstrated that high H-FABP (hazard ratio 1.76, p=0.0142) and QRS prolongation (hazard ratio 1.55, p=0.0418) were independent predictors of cardiac events. Kaplan-Meier analysis demonstrated that the combination of high H-FABP level and QRS prolongation could reliably stratify patients for cardiac events (log rank test p<0.0001). The high H-FABP and QRS prolongation group had higher risk for cardiac events compared with the other groups. ![Figure][1] Conclusion: The combination of high H-FABP and QRS prolongation can risk stratify CHF patients. [1]: pending:yes