Heart-type Fatty Acid-binding Protein Levels Research Articles

Ventricular wall stress and silent myocardial damage are associated with pulse pressure in the general population.

Pulse pressure (PP) is a risk factor for cardiovascular diseases and is associated with increased afterload and myocardial oxygen demand. Brain natriuretic peptide (BNP) and heart-type fatty acid-binding protein (H-FABP) are known as biomarkers indicating ventricular wall stress and silent myocardial damage. However, the association between PP and ventricular wall stress and silent myocardial damage in the general population is unclear. The authors enrolled 3504 patients who participated in a community-based annual health check. Serum levels of BNP and H-FABP were measured as markers of ventricular wall stress and silent myocardial damage. Patients were divided into four groups according to the quartiles of PP. Patients in the highest PP group showed higher serum BNP and H-FABP levels than that of the other groups. Multivariate logistic analysis showed that high PP was independently associated with ventricular wall stress and silent myocardial damage on the basis of BNP and H-FABP levels. Compared with systolic blood pressure, diastolic blood pressure, and mean blood pressure, PP was superior in predicting ventricular wall stress and silent myocardial damage evaluated according to BNP and H-FABP levels, which was reflected by the receiver operating characteristic analysis. Screening of healthy patients revealed that high PP was related to high BNP and H-FABP levels, suggesting that an asymptomatic general population with high PP may be exposed to ventricular wall stress and myocardial damage and might be susceptible to silent heart failure.

Significance of heart-type fatty acid binding protein and brain glycogen phosphorylase isoenzyme type in septic myocardial injury

Objective To demonstrate the relevance of heart-type fatty acid binding protein(H-FABP) and brain glycogen phosphorylase isoenzyme type(GPBB) with myocardial injury in sepsis.To explore the effect of H-FABP and GPBB on the severity of disease and clinical prognosis. Methods A total of 40 cases of children with sepsis were selected in this study from January 1, 2017 to October 31, 2017.According to the illness severity, they were divided into sepsis group(n=15), severe sepsis group(n=13) and septic shock group(n=12), 19 cases of children with non-infectious diseases were selected as the control group for the same period.The levels of serum WBC, C-reactive protein, procalcitonin, cTnI, CK, CK-MB, CK-MB isoenzyme quality and NT-proBNP were collected within 24 hours of admission.The APECHEⅡ scores were calculated for each child.The peripheral blood of the patients within 24 hours after admission was used to determine the levels of serum H-FABP and GPBB by ELISA method.The differences of clinical indicators among the groups were analyzed.According to the survival of patients with sepsis, they were divided into 37 cases in the improved group and 3 cases in the death group.All patients with sepsis were divided into left ventricular ejection fraction(LVEF) normal group(n=26) and LVEF decreased group(n=14). According to whether the serum cTnI was elevated, all children with sepsis were divided into cTnI normal group (n=29) and cTnI increased group (n=11). The differences of H-FABP and GPBB levels were compared.According to the presence or absence of LVEF decline, the area under the ROC curve was used to evaluate the predictive power of each index for myocardial injury in sepsis.Based on the decrease of LVEF, the area under the ROC curve was used to evaluate the prediction of each index for myocardial injury in sepsis. Results There were significant differences in H-FABP and GPBB levels among the control group, sepsis group, severe sepsis group and the septic shock group (H=42.241, P 0.05), there was an elevated trend of H-FABP and GPBB in the death group.The levels of H-FABP (t=-3.770, P=0.001) and GPBB (Z=-2.113, P=0.033) were statistically significant in the LVEF normal group and the LVEF decreased group (LVEF≤60%). There were no significant differences in the levels of H-FABP and GPBB between the cTnI normal group and the cTnI increased group (P>0.05), but the cTnI increased group had an increasing trend.The area under the ROC curve in the diagnosis of myocardial injury in sepsis were H-FABP 0.821, NT-ProBNP 0.738, GPBB 0.661, CK 0.560, cTnI 0.512, in which the sensitivity(0.833) and specificity(0.786)of H-FABP were both higher. Conclusion The serum H-FABP and the GPBB levels can be used to monitor for myocardial damage, and it has a correlation with the severity of the disease and the prognosis.H-FABP has a significant advantage over traditional myocardial markers in sensitivity and specificity to determine the myocardial injury of sepsis. Key words: Sepsis; Myocardial injury; Cardiac markers; Heart-type fatty acid binding protein; Brain glycogen phosphorylase isoenzyme type

Risk stratification of acute pulmonary embolism based on clinical parameters, H-FABP and multidetector CT

IntroductionRisk stratification of normotensive patients with acute pulmonary embolism (PE) includes the assessment of right ventricular dysfunction (RVD), biomarker levels, and a clinical score as suggested by the 2014 guidelines of the European Society of Cardiology (ESC). We performed an external validation of the prognostic performance of Heart-type Fatty Acid Binding Protein (H-FABP) and incorporated it into the new ESC algorithm. Material and methodsH-FABP was measured by fully-automated immunoturbidimetry in 716 patients from the PROTECT study (PROgnosTic valuE of CT scan in haemodynamically stable patients with acute symptomatic PE). ResultsH-FABP ranged from 0.7 to 123.6 ng/ml (median 4.13; IQR, 2.53–6.61) and was above the cut-off of 6 ng/ml in 209 patients (29.2%). A complicated course within 30 days (death, catecholamine administration, mechanical ventilation, resuscitation) occurred in 1.1% (n = 3) of the 271 low risk patients with a simplified Pulmonary Embolism Severity Index (sPESI) of 0 and was particular low (0.4%), if H-FABP levels were normal. In the case of elevated H-FABP, 4.3% of patients suffered complications despite sPESI of 0. The risk for an adverse 30-day outcome increased for patients of the intermediate-low and intermediate-high risk group and was highest for the combination of sPESI ≥1 with RVD on MDCT and elevated H-FABP (odds ratio 12.3, 95% confidence interval, 3.49–43.32; P < 0.001). ConclusionsH-FABP is suitable for risk stratification of normotensive PE patients if integrated in the new ESC algorithm and may help to identify patients with higher risk for adverse clinical events.

Complementary Diagnostic Value of Heart Type Fatty Acid-binding Protein in Early Detection of Acute Myocardial Infarction.

Heart-type fatty acid-binding protein (H-FABP) is a novel biomarker for myocardial injury. We compared the use of H-FABP with serum levels of cardiac troponin-T (cTnT) and creatine kinase-MB (CK-MB) in the diagnosis of patients suspicious to acute myocardial infarction (AMI). From October 2013 to December 2014, 182 consecutive patients suspicious to acute coronary syndrome were enrolled in this study, who presented within the past 6 hours from the onset of symptoms. Venous blood samples were drawn at baseline to measure serum biochemistry, high-sensitive cardiac troponin T (hs-cTNT), creatine kinase-MB, and H-FABP, and the measurements were repeated after 8 hours. The patients were categorized into 3 groups based on the baseline and second measurements of cTnT and general characteristics, and changes of H-FABP levels were then compared between the groups. Sensitivity and specificity of H-FABP in predicting the presence of AMI was calculated. A total of 91 patients had AMI. Changes of H-FABP through time were also significantly different between the AMI and non-AMI patients (P < 0.001). A cutoff point of 7.15 for H-FABP could predict AMI with a sensitivity of 51.5%, specificity of 96.3%, and diagnostic accuracy of 68.3%. The area under the receiver operating characteristic curve for H-FABP at 8 hours was 79.4% (95% confidence interval: 73.0-85.9; P < 0.001). Positive predictive value and negative predictive value for H-FABP were 85% and 60%, respectively. H-FABP can be used as an additional cardiac biomarker in the diagnosis of AMI.

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

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

Presence of Myocardial Damage Predicts Future Development of Hypertension in a Normotensive Japanese General Population: The Yamagata (Takahata) Study.

A modest rise in blood pressure (BP) reportedly increases cardiovascular mortality despite not reaching obvious hypertension, suggesting that target organ damages are latently induced by slight BP rising. The goal of this study was to determine whether presence of subclinical myocardial damage can predict the future development of hypertension in the normotensive general population. The cohort study was conducted with subjects who participated in a community-based annual health check. Normotensive subjects without prior cardiovascular diseases at baseline were eligible for analyses (n = 524, mean age 58 ± 9 years; 53% women). We measured heart-type fatty acid binding protein (H-FABP) at baseline as a biomarker of ongoing myocardial damage. Longitudinal changes in BP were examined during median follow-up period of 6.2 years, and we investigated the association between the baseline H-FABP level and longitudinal BP changes. During the follow-up, 177 subjects (34%) developed hypertension. In multivariate Cox proportional hazard analysis adjusted for potential confounders including age and baseline BP, presence of myocardial damage was significantly associated with the development of hypertension (hazard ratio 1.80, 95% confidence interval, 1.26-2.54; P = 0.0014). Furthermore, relative risk of myocardial damage for incident hypertension was higher in younger subjects and lower BP category. Presence of subclinical myocardial damage was independently associated with the future development of hypertension in the normotensive general population.

Heart-type fatty-acid-binding protein is a prognostic biomarker for sepsis outcome and sepsis-related left-ventricular dysfunction: a comparison with troponin I

Background Using heart-type fatty-acid-binding protein (H-FABP) in critically ill patients provides a superior results than the conventional cardiac biomarkers. Objective The aim of the study was to estimate the prognostic significance of H-FABP in patients with septic shock and the prevalence of sepsis-related myocardial dysfunction in comparison to troponin I. Patients and methods Fifty ICU patients with sepsis were enrolled in this study. All patients were evaluated using Acute Physiology and Chronic Health Evaluation II score on admission and every 24 h during ICU stay. Serum levels of both H-FABP and troponin I were investigated during the first 24 h after admission. Using modified Simpson’s method, echocardiographic left-ventricular end-diastolic volume (LVEDV), left-ventricular end-systolic volume (LVESV), and left-ventricular ejection fraction (LV%EF) were calculated on admission and after 24 h. Results The patients were divided into two groups: group 1, which included 12 patients (mean age: 50.2±21 years) suffering from sepsis; and group 2, which included 38 patients (mean age: 58.4±19.2 years) with septic shock. Compared with group 1, H-FABP of group 2 showed significant higher values (76.3 vs. 33.3% of patients, P Conclusion In septic shock, H-FABP can be used as a prognostic marker for mortality rathar than troponin I. The positive H-FABP patients showed a significant relation with sepsis-related left-ventricular systolic myocardial dysfunction.

PROTEIN MARKERS OF CARDIONECROSIS IN THE DYNAMICS OF ACUTE CORONARY SYNDROME

The aim of this study was to compare and analyze the effectiveness of protein markers of myocardial necrosis - heart-type fatty acid-binding protein (H-FABP) and the MB fraction of creatine phosphokinase (CPK-MB) in the dynamics of acute coronary syndrome. Material and methods. A total of 49 patients (57.1 ± 11,0 years) were examined, including 36 male patients (73.5 %) who were admitted to the City Clinical Hospital No. 34 of Novosibirsk with suspected acute coronary syndrome. The content of H-FABP in whole venous blood was evaluated for all patients upon admission to the hospital with the means of the immunochromatographic rapid test «CardioPBFA» (NPO «Biotest», Novosibirsk) with a sensitivity of 15 ng/ml. Determination of CPK-MB was carried out repeatedly in the first 48 hours from the beginning of the clinical manifestations of the disease, using immunochemiluminometric assay. Results and discussion. It was revealed that in patients with myocardial infarction (MI), CPK-MB content after 6-24 hours and also after 24-48 hours from the onset of pain was significantly higher than in patients without MI. H-FABP content 15 ng/ml and more, determined in the majority of patients in the first 6 hours from the onset of pain, was recorded much more often in MI presence than in MI absence. Using partial correlation analysis, it was determined that age influenced the association of MI with CPK-MB 6-24 hours after the onset of pain (which is probably due to the increase in the influence of a number of factors modulating the level of protein cardiac markers with age), and the correlation of MI with CPK-MB in 24-48 hours from the onset of pain did not depend on this factor ( r = 0.322; p = 0.46). In the regression model (χ² = 13.6; p = 0.001) it was revealed that H-FABP content 15 ng/ml and more regardless of age ( p = 0.006) is associated with the presence of MI in the patients, which confirms information about the high significance of identifying this H-FABP level in early diagnosis of myocardial infarction.

Influences of Ivabradine treatment on serum levels of cardiac biomarkers sST2, GDF-15, suPAR and H-FABP in patients with chronic heart failure

Chronic heart failure (CHF) represents a major cause of hospitalization and death. Recent evidence shows that novel biomarkers such as soluble suppression of tumorigenicity (sST2), growth-differentiation factor-15 (GDF-15), soluble urokinase plasminogen activator receptor (suPAR) and heart-type fatty acid binding protein (H-FABP) are correlated with inflammatory and ischemic responses in CHF patients. In this study we examined the effects of Ivabradine that inhibited the hyperpolarization-activated cyclic nucleotide-gated channel (HCN channel, also called funny current If), thereby leading to selective heart rate reduction and improved myocardial oxygen supply on the cardiac biomarkers sST2, GDF-15, suPAR and H-FABP in 50 CHF patients at the University Hospital of Jena. Patients were divided into three groups based on the etiology of CHF: dilated cardiomyopathy (DCM, n=20), ischemic cardiomyopathy (ICM, n=20) and hypertensive cardiomyopathy (HCM, n=10). The patients were administered Ivabradine (5 mg, bid for 3 months, and 7.5 mg bid for further 3 months). Analyses of cardiovascular biomarkers were performed at baseline as well as at 3- and 6-month follow-ups. At 6-month follow-up, GDF-15 levels were significantly reduced compared to baseline levels (P=0.0215), indicating a reduction in the progress of cardiac remodeling. H-FABP concentration was significantly lower in DCM patients compared to ICM (1.89 vs 3.24 μg/mL) and HCM patients (1.89 vs 3.80 μg/mL), and decreased over the 6-month follow-up (P=0.0151). suPAR median levels remained elevated, implying major ongoing inflammatory processes. As shown by significant decreases in GDF-15 and H-FABP levels, a reduction in ventricular remodeling and sub-clinical ischemia could be assumed. However, markers of hemodynamic stress (sST2) and inflammation (suPAR) showed no change or progression after 6 months of Ivabradine treatment in CHF patients. Further studies are necessary to validate the clinical applicability of these novel cardiovascular biomarkers.

Heart-type fatty acid binding protein levels in elderly diabetics without known cardiovascular disease.

BackgroundCardiovascular disease (CVD) is reported to be higher in elderly diabetics. Serum heart-type fatty acid binding protein (H-FABP) is a serum marker of myocardial ischemia. We aimed to investigate the association between serum H-FABP level and conventional cardiovascular risk factors, inflammatory markers and subclinical atherosclerosis in elderly diabetics without overt CVD.Patients and methodsA total of 50 elderly diabetic patients without overt CVD and 30 age-, sex- and body mass index (BMI)-matched healthy controls were enrolled. Anthropometric and biochemical parameters, serum H-FABP, high-sensitivity C-reactive protein (hs-CRP), fibrinogen and carotid intima-media thickness (CIMT) were measured. Logistic regression analyses (adjustments for age, sex, hypertension, smoking, diabetes, BMI, blood pressure, lipid, blood glucose, hemoglobin A1c, hs-CRP and fibrinogen) were performed to evaluate the association between H-FABP and cardiovascular risk factors and atherosclerosis indices.ResultsSerum fibrinogen (421.50±85.52 mg/dL vs 319.17±30.77 mg/dL, p=0.023), CIMT (0.70±0.12 mm vs 0.59±0.06 mm, p<0.001) and hs-CRP (5.72±4.50 mg/dL vs 1.60±0.72 mg/dL, p<0.001) were significantly higher in diabetic patients than controls. The mean serum H-FABP level did not differ between groups (1571.79±604.60 ng/mL vs 1500.25±463.35 ng/mL, p=0.905). H-FABP was positively correlated with fibrinogen (r2=0.473, p<0.001), hs-CRP (r2=0.323, p=0.003) and CIMT (r2=0.467, p<0.001). After full adjustments, the serum H-FABP level was independently associated with an increase in the fibrinogen level (odds ratio [OR] =4.21, 95% confidence level [CI] =1.49–11.90).ConclusionSerum H-FABP was similar in the elderly diabetic patients without known CVD when compared with the nondiabetic control group. H-FABP does not possess a high diagnostic value as a cardiovascular marker when used alone; however, it may add supplementary information in patients with a high fibrinogen level.

Gender differences in the impact of anemia on subclinical myocardial damage and cardiovascular mortality in the general population: The Yamagata (Takahata) study.

Anemia has been shown to worsen cardiovascular diseases. However, it is unclear whether there is a gender difference in the impact of anemia on subclinical myocardial damage and cardiovascular mortality in the general population. A prospective cohort study was conducted in a community based on annual health checks. Serum heart-type fatty acid binding protein (H-FABP) levels, which is a marker for myocardial damage, and blood counts were measured at baseline in subjects without previous cardiovascular diseases (n=3111). There were 343 subjects (11.0%) with anemia at baseline. H-FABP levels were inversely correlated with hemoglobin concentrations in male subjects, whereas there was no such correlation in female subjects, irrespective of the status of menopause. Prevalence of myocardial damage (H-FABP ≥4.3ng/ml) was significantly higher in male subjects with anemia than those without, irrespective of the type of anemia (microcytic, normocytic, and macrocytic). Multivariate logistic regression analysis revealed that anemia was an independent predictor of myocardial damage after adjusting for confounders. During 10years of follow-up, there were 204 all-cause deaths including 57 cardiovascular deaths. Kaplan-Meier analysis demonstrated that cardiovascular mortality was higher in male subjects with anemia than in those without. However, anemia was not associated with cardiovascular mortality in female subjects. Multivariate Cox proportional hazard analysis revealed that anemia was an independent predictor of all-cause and cardiovascular mortalities after adjusting for confounders. Anemia was an independent predictor of all-cause and cardiovascular mortalities, and subclinical myocardial damage in male subjects, but not in female subjects.

Effects of dexmedetomidine on H-FABP, CK-MB, cTnI levels, neurological function and near-term prognosis in patients undergoing heart valve replacement.

This study investigated the effects of dexmedetomidine on heart-type fatty acid binding protein (H-FABP), creatine kinase isoenzymes (CK-MB), and troponin I (cTnI) levels, neurological function and near-term prognosis in patients undergoing heart valve replacement. Patients undergoing heart valve replacement were randomly allocated to remifentanil anesthesia (control group, n=48) or dexmedetomidine anesthesia (observation group, n=48). Hemodynamic parameters were measured before anesthesia induction (T1), 1 min after intubation (T2), 10 min after start of surgery (T3), and on completion of surgery (T4). Levels of plasma H-FABP, CK-MB and cTnI were measured 10 min before anesthesia induction (C1), 10 min after start of surgery (C2), on completion of surgery (C3), 6 h after surgery (C4), and 24 h after surgery (C5). S100β protein and serum neuron-specific enolase (NSE) were detected 10 min before anesthesia induction (C1), and 24 h after surgery (C5). Neurological and cardiac function was evaluated 24 h after surgery. Incidence of cardiovascular adverse events was recorded for 1 year of follow-up. There were no significant differences in the average heart rate between the two groups during the perioperative period. The mean arterial pressure in the observation group was significantly lower than control group (P<0.05). Levels of H-FABP, CK-MB and cTnI at C2, C3, C4 and C5, were significantly higher than C1, but significantly lower in the observation versus control group (P<0.05). Twenty-four hours after surgery, levels of S100β and NSE in both groups were higher than those before induction (P<0.05), but significantly lower in the observation versus control group (P<0.05). Twenty-four hours after surgery, neurological function scores were better, and myocardial contractility and arrhythmia scores significantly lower in the observation versus control group (P<0.05 for all). After follow-up for 1 year, incidence of cardiovascular adverse events was significantly lower in the observation versus control group (P<0.05). Dexmedetomidine anesthesia can effectively maintain hemodynamic stability, reduce myocardial injury and the occurrence of cognitive dysfunction, and improve prognosis in patients undergoing heart valve replacement.

P28-5 - The Impact of Pulse Pressure on Silent and Ongoing Myocardial Damage in the General Population

Background: Pulse pressure (PP) is associated with increased afterload and myocardial oxygen demand. PP is also associated with poor prognosis in patients with myocardial infarction and heart failure with preserved ejection fraction. Silent myocardial damage is associated with cardiovascular mortality in the general population. The aim of this study was to investigate the relationship between PP and silent myocardial damage in the general population. Methods and Results: The present study included 3505 subjects who participated in health checkup. We measured serum heart-type fatty acid binding protein (H-FABP) and brain natriuretic peptide (BNP) levels as markers of silent myocardial damage. Subjects were divided into four groups according to the quartiles of PP. Subjects with the highest PP group showed higher serum H-FABP and BNP levels. Multivariate logistic analysis showed that the higher PP was independently associated with silent myocardial damage evaluated by H-FABP (odds ratio (OR): 1.12, P < .05) and BNP (OR: 1.10, P < .05). Receiver operating characteristic (ROC) analysis showed that PP performed best in predicting silent myocardial damage evaluated by H-FABP and BNP compared with systolic blood pressure (BP), diastolic BP, and mean BP (c-index regarding H-FABP: 0.61, P < .05; c-index regarding BNP: 0.61, P < .05). Conclusions: High PP was related to higher H-FABP and BNP levels, suggesting that asymptomatic subjects with high PP may be exposed to myocardial damage.

Heart-Type Fatty Acid-Binding Protein (H-FABP) in Patients with Coronary Artery Bypass Graft Surgery Undergoing Cardiac Rehabilitation Program

Heart-type Fatty Acid-Binding Protein (H-FABP), compared with classical biomarkers, proved to have high sensitivity for myocardial damage size in patients undergoing cardiac surgery. High H-FABP levels are strongly associated in case of death, post-operatively acute kidney injury and atrial fibrillation. Cardiac rehabilitation is an instrument of medical management in cardiovascular diseases; beyond prevention, it can improve heart and muscle functioning in patients that were undergoing CABG, and cardiac and vascular adaptation. Over a 2-year period, 110 subjects were randomized and comprehensively evaluated. The mean age of the patients under study was 65.70 � 9.91 years old. For the H-FABP, the mean value in the Phase I was 67.40 � 9.81 ng/mL, while the mean value in Phase III was 4.80 � 2.30 ng/mL. The difference registered between the plasma H-FABP value in the first 24 h after cardiac surgery and the value in 6 months after the onset of cardiac rehabilitation program was important and statistically significant, as p [ 0.05. Fibrinogen showed significant phase-to-phase reductions of plasmatic values. Lipid profile values showed a statistically significant decrease. The renal filtration function evaluated by plasma creatinine showed statistically significant improvement and, in terms of absolute values, creatinine level was reduced in a range between 0.2-0.4 mg/dL. Also, it was recorded a significantly lower level of blood urea. The reduction of plasma H-FABP values were registered between the first phase (the first 24 h) after cardiac surgery and the third phase of the cardiac rehabilitation program. H-FABP protein had a higher sensitivity and specificity when compared to other enzymes of myocardial cytolysis.

Combined assessment of myocardial damage and electrical disturbance in chronic heart failure.

AIMTo investigate feasibility of combined assessment of biochemical and electrophysiological myocardial impairment markers risk-stratifying patients with chronic heart failure (CHF).METHODSSerum levels of heart-type fatty acid binding protein (H-FABP) as a marker of ongoing myocardial damage and QRS duration on electrocardiogram were measured at admission in 322 consecutive patients with CHF. A prolonged QRS duration was defined as 120 ms or longer. The cut-off value for H-FABP level (4.5 ng/mL) was determined from a previous study. Patients were prospectively followed during a median follow up period of 534 d. The primary endpoint was cardiac deaths and rehospitalization for worsening CHF.RESULTSThere were 117 primary events, including 27 cardiac deaths and 90 rehospitalizations. Patients were stratified into four groups according to H-FABP level and QRS duration (≥ 120 ms). Multivariate analysis demonstrated that high H-FABP levels [hazard ratio (HR) = 1.745, P = 0.021] and QRS prolongation (HR 1.612, P = 0.0258) were independent predictors of cardiac events. Kaplan-Meier analysis demonstrated that the combination of high H-FABP levels and QRS prolongation could be used to reliably stratify patients at high risk for cardiac events (log rank test P < 0.0001).CONCLUSIONCombined assessment of myocardial damage and electrical disturbance can be used to risk-stratify patients with CHF.

Increment of HFABP Level in Coronary Artery In-Stent Restenosis Segments in Diabetic and Nondiabetic Minipigs: HFABP Overexpression Promotes Multiple Pathway-Related Inflammation, Growth and Migration in Human Vascular Smooth Muscle Cells

Background: Our previous study suggested that heart-type fatty acid-binding protein (HFABP) levels were greatly elevated in the conditioned medium of explant culture of in-stent restenosis (ISR) tissue from diabetic minipigs compared with those of non-ISR tissue. We here verified this result in animal tissues and investigated the impact of HFABP overexpression in human aortic smooth muscle cells (hASMCs). Methods and Results: In Western blot and real-time RT-PCR, HFABP protein and mRNA levels were significantly higher in ISR than in non-ISR tissues from minipigs, and higher in the ISR tissue from diabetic minipigs than that from nondiabetic minipigs. The mRNA microarray and cellular effects of hASMC retroviral overexpression of HFABP and vector was analyzed. Compared with vector, HFABP transduction activates multiple signaling pathways (e.g. adipokine, TGF-β, Toll-like receptor, Wnt, Hedgehog, ErbB and Notch) and promotes inflammation, growth and migration in hASMCs whereas the knockdown of HFABP by small hairpin RNA attenuates these effects. Conclusion: HFABP expression is significantly higher in ISR tissue than in non-ISR tissue from diabetic and nondiabetic minipigs. Overexpression of HFABP induces multiple pathway-related promotion of inflammation, growth and migration in vascular SMCs, suggesting a potential role in coronary artery ISR.

The Prognostic Value of Serum Levels of Heart-Type Fatty Acid Binding Protein and High Sensitivity C-Reactive Protein in Patients With Increased Levels of Amino-Terminal Pro-B Type Natriuretic Peptide.

BackgroundAmino-terminal pro-B type natriuretic peptide (NT-proBNP) is a well-established prognostic factor in heart failure (HF). However, numerous causes may lead to elevations in NT-proBNP, and thus, an increased NT-proBNP level alone is not sufficient to predict outcome. The aim of this study was to evaluate the utility of two acute response markers, high sensitivity C-reactive protein (hsCRP) and heart-type fatty acid binding protein (H-FABP), in patients with an increased NT-proBNP level.MethodsThe 278 patients were classified into three groups by etiology: 1) acute coronary syndrome (ACS) (n=62), 2) non-ACS cardiac disease (n=156), and 3) infectious disease (n=60). Survival was determined on day 1, 7, 14, 21, 28, 60, 90, 120, and 150 after enrollment.ResultsH-FABP (P<0.001), NT-proBNP (P=0.006), hsCRP (P<0.001) levels, and survival (P<0.001) were significantly different in the three disease groups. Patients were divided into three classes by using receiver operating characteristic curves for NT-proBNP, H-FABP, and hsCRP. Patients with elevated NT-proBNP (≥3,856 pg/mL) and H-FABP (≥8.8 ng/mL) levels were associated with higher hazard ratio for mortality (5.15 in NT-proBNP and 3.25 in H-FABP). Area under the receiver operating characteristic curve analysis showed H-FABP was a better predictor of 60-day mortality than NT-proBNP.ConclusionsThe combined measurement of H-FABP with NT-proBNP provides a highly reliable means of short-term mortality prediction for patients hospitalized for ACS, non-ACS cardiac disease, or infectious disease.

The association between defibrillation shock energy and acute cardiac damage in patients with implantable cardioverter defibrillators

BackgroundThe aim of this study was to establish a minimally invasive defibrillation testing (DT) protocol for patients with implantable cardioverter defibrillators (ICDs). MethodsTwo different energy DTs were performed, immediately after (15J-DT) and 7 days after (≤10J-DT) device implantation, in 20 consecutive ICD implantation patients. Cardiac-troponin T (c-TNT) and heart-type fatty acid binding protein (H-FABP) levels were measured before implantation, 2h after implantation, and 1 day after each DT. For an additional 122 patients with ICD, we retrospectively analyzed 203 DTs immediately and 7 days after device implantation. ResultsSerum c-TNT levels were significantly elevated 2h after 15J-DT [0.008 (0.004–0.019) vs. 0.053 (0.037–0.068)ng/mL, p<0.001], but not ≤10J-DT [0.007 (0.004–0.018)ng/mL]. Similarly, serum H-FABP levels were significantly elevated 2h after 15J-DT (2.9±1.5 vs. 6.4±3.4ng/mL, p<0.001), but not ≤10J-DT (2.7±1.5ng/mL). The changes in c-TNT and H-FABP levels between baseline and 2h after DT were significantly greater for 15J-DT compared with ≤10J-DT [c-TnT: 0.039 (0.029–0.060) vs. 0 (0–0.003)ng/mL, p<0.001; H-FABP: 3.6±2.8 vs. −0.16±1.1ng/mL, p<0.001]. The success rates of the initial shocks delivered for ventricular fibrillation were no different between ≤10J-DT (85% [78/92]) and ≥15J-DT (92% [103/111]). ConclusionsElevated levels of myocardial damage markers such as c-TNT and H-FABP were not found after ≤10J-DT. In addition, an acceptable success rate was confirmed in ≤10J-DT.

Heart-type fatty acid binding protein and cardiac troponin I may have a diagnostic value in electrocution: A rat model

Although cardiac injury is known to be the leading cause of death in electrocution, the differential diagnosis can be challenging in forensic practice since the exact mechanism is poorly understood and there is lack of reliable markers. Thus, death due to electrocution may be classified as a negative autopsy. The serum levels of and myocardial immunostaining loss for cardiac troponins and heart-type fatty acid binding protein (H-FABP) are highly sensitive and specific biomarkers of ischemic myocardial damage and may have a diagnostic value in determining the myocardial injury or the cause of death due to electrocution. Due to this reason, a rat model is prepared to investigate these issues. Thirty-two Wistar albino female rats were included and randomly divided into four groups of eight subjects. Group A was the control group, and Group B, C, and D were exposed to electrical current of 110 volt (V), 220 V, and 600 V, respectively. Blood samples and the hearts were collected from the rats for biochemical and immunostaining analyses.It is found that increased serum H-FABP levels were significantly associated with the higher voltage immediately after electrocution. However, serum cardiac troponin I (cTnI) levels did not show significant changes associated with the higher voltage in the early period of electrocution. As for histopathological examinations, the only significant difference in myocardial immunostaining loss was for H-FABP in Group B.Serum H-FABP levels may have a diagnostic value in the early postmortem period immediately after electrocution. Besides, it seems that serum H-FABP levels may be a better indicator than those of cTnI to reflect the myocardial damage in the early period of the electrocution.

Heart-type fatty acid-binding protein as a predictor of cardiac ischemia in intractable seizures in children.

Background:Children with intractable epilepsy have chronic dysfunction of the autonomic nervous system causing myocardial ischemia. Heart-type fatty acid-binding protein (H-FABP) is a sensitive biomarker for myocardial ischemia.Aims:We aimed to evaluate serum levels of H-FABP during seizures compared to their interictal levels and healthy controls and changes in heart rate (HR) and HR variability (HRV) in epileptic children with intractable seizures.Materials and Methods:We included 30 epileptic seizures in 25 children with intractable epilepsy and 30 matched controls. They were subjected to video-electroencephalography monitoring simultaneously with Holter electrocardiogram and measurement of H-FABP.Results:Mean serum levels of H-FABP were increased significantly in patients either in the ictal or interictal periods compared to that in the controls (P < 0.001 and P< 0.01, respectively). There is no significant difference in serum levels of the H-FABP in the ictal and interictal periods. The basal time domain measures of HRV were significantly lower in the patient group compared to the control group.Conclusion:H-FABP might suggest a degree of myocardial ischemia in intractable epilepsy. HRV is impaired in patients with refractory seizures.