Heart-type Fatty Acid-binding Protein Research Articles

Determination of 97.5th and 99th percentile upper reference limits for heart-type fatty acid-binding protein (H-FABP) in a US population

BackgroundHeart-type fatty acid binding protein (H-FABP), a low molecular weight protein found primarily in myocardial tissue, has been identified as a potential biomarker in the detection of acute coronary syndrome and acute kidney injury. To further investigate clinical utility, we sought to establish an upper reference limit (URL) of H-FABP within a healthy U.S. population. MethodsSerum samples of healthy donors were acquired from the AACC Universal Sample Bank. We analyzed 355 samples for H-FABP concentration using the Randox Laboratories immunoturbidimetric assay on the Roche Cobas 8000 series analyzer. ResultsThe final sample population consisted of individuals aged 18–74 y, with 170 males and 185 females. The distribution of the population exhibited a strong positive skew, affecting outlier analysis and URL determination. The 97.5th-percentile URL was found to be 7.4 ng/ml (95% CI: 6.3–9.2), while the 99th-percentile URL was 12.1 ng/ml (8.6–14.9). ConclusionAs the URL for H-FABP is highly affected by population distribution and outlier removal, final determination for an assay cutoff should be made in the context of clinical utility, either as a standalone assay or in conjunction with other biomarkers, and the desired clinical sensitivity and specificity.

Evaluation of the effects of interval hypoxic-hyperoxic training in patients with metabolic syndrome

Abstract Introduction Metabolic syndrome (MS) as a “cluster” of interrelated disorders, including insulin resistance, visceral obesity, dyslipidemia, and hypertension, is an serious clinical problem that is a high risk factor for the development of type 2 diabetes, acceleration of the development and progression of cardiovascular diseases, and such increasingly common liver damage like non-alcoholic fatty liver disease. According to a number of authors, metabolic syndrome is a reversible condition, and with early diagnosis and treatment, a reduction in the severity of manifestations of this syndrome can be achieved. A significant role in the treatment of MS and obesity is played by non-drug methods – dosed physical activity, diet, various physiotherapeutic procedures, as well as interval hypoxic-hyperoxic training (IHHT). Objective Evaluation of the effect of interval hypoxic-hyperoxic training (IHHT) on the components of metabolic syndrome, and the possibility of their reversal recovery. Materials and methods The study included 65 patients (33 men) with metabolic syndrome, aged 29–66 years. The patients were divided into 2 groups: study and control (the groups were matched by sex, age, presence of MS components and number of comorbidities). Initially, anthropometric, laboratory and instrumental studies were carried out. The patients of the main group underwent a course of IHHT for 3 weeks, 5 days a week (15 workouts). Patients in the control group underwent a course of training simulating IHHT (placebo), which also consisted of 15 trainings. The duration of one procedure was 40 minutes. Next day after the end of the training course, the changes in all initial parameters were assessed. Results The statistical significance of changes after the IGGT course was assessed using the Wilcoxon test as p<0.05 and was detected in the main group according to the following parameters: reduction in arterial stiffness, measured using CAVI (Cardio-Ankle Vascular Index, on the Fukuda Denshi ap.), a decrease in the stage of liver fibrosis and stiffness of liver tissue (was realized by a non-invasive method, a liver elastometry, on the FibroScan ap. Echosense), a decrease in high-sensitivity C-reactive protein, heat shot protein-70, a decrease in total cholesterol, low density lipoproteins, triglycerides levels. According to nitric oxide, transforming growth factor beta-1, heart-type fatty acid binding protein, there was no significant dynamics after the IHHT course in both groups. There was also a tendency towards a decrease in the indices of the abdominal/hip circumference, weight, and in blood pressure, but this results was not statistically significant, due to the insufficient power of the study (a small number of patients). Conclusions IHHT is a safe, well-tolerated procedure and is recommended in the therapeutic and prophylactic plan for patients with metabolic syndrome, and is effective in correcting and minimizing the components of this syndrome. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This work was financed by the Ministry of Science and Higher Education of the Russian Federation within the framework of state support for the creation and development of World-Class Research Centers “Digital biodesign and personalized healthcare”

Dynamic Changes of Serum Heart Type-Fatty Acid Binding Protein in Cancer Patients Treated With Immune Checkpoint Inhibitors.

Objective: Immune checkpoint inhibitors (ICIs) are effective anti-cancer drugs that can improve survival in cancer patients, but their use may be associated with adverse cardiovascular side effects. Therefore, there is a clinical unmet need to identify non-invasive biomarker to detect subclinical cardiac toxicity after ICI treatment. The aim of this study is to examine the plasma levels of biomarkers in cancer survivors who were treated with ICIs. Patients and Methods: In a cohort of 19 cancer patients, biomarkers were evaluated at baseline, 1 month, 3 and 6 months after ICI administration. These biomarkers, hypothesized to be mechanistically relevant to cardiotoxicity, included cardiac troponin I (cTnI), high-sensitivity C-reactive protein (Hs-CRP), N-terminal pro–B-type natriuretic peptide (NT-pro BNP), CK (creatine kinase), CK-MB (creatine kinase-MB), Pentraxin-related protein 3 (PTX3), growth differentiation factor 15 (GDF-15), heart type-fatty acid binding protein (H-FABP) and galectin 3 (Gal-3). Results: H-FABP, but not other biomarkers, were increased at 3 months, which persisted at 6 months (529.28 ± 312.83 vs. 752.33 ± 283.65 vs. 808.00 ± 289.69 pg/ml, p = 0.031 and p = 0.013). Left ventricular ejection fraction (63.00 ± 4.15% vs. 63.74 ± 4.07%, p > 0.05) was not significantly reduced at this time point. Conclusions: H-FABP, but not other biomarkers, were increased in patients who were treated using ICIs. H-FABP might be a more sensitive biomarker to detect ICI-related subclinical myocardial damage than traditional cardiac biomarkers.

Circulating Biomarkers for Cardiovascular Disease Risk Prediction in Patients With Cardiovascular Disease.

Cardiovascular disease (CVD) is the leading cause of death globally. Risk assessment is crucial for identifying at-risk individuals who require immediate attention as well as to guide the intensity of medical therapy to reduce subsequent risk of CVD. In the past decade, many risk prediction models have been proposed to estimate the risk of developing CVD. However, in patients with a history of CVD, the current models that based on traditional risk factors provide limited power in predicting recurrent cardiovascular events. Several biomarkers from different pathophysiological pathways have been identified to predict cardiovascular events, and the incorporation of biomarkers into risk assessment may contribute to enhance risk stratification in secondary prevention. This review focuses on biomarkers related to cardiovascular and metabolic diseases, including B-type natriuretic peptide, high-sensitivity cardiac troponin I, adiponectin, adipocyte fatty acid-binding protein, heart-type fatty acid-binding protein, lipocalin-2, fibroblast growth factor 19 and 21, retinol-binding protein 4, plasminogen activator inhibitor-1, 25-hydroxyvitamin D, and proprotein convertase subtilisin/kexin type 9, and discusses the potential utility of these biomarkers in cardiovascular risk prediction among patients with CVD. Many of these biomarkers have shown promise in improving risk prediction of CVD. Further research is needed to assess the validity of biomarker and whether the strategy for incorporating biomarker into clinical practice may help to optimize decision-making and therapeutic management.

Effect of N‑terminal region of human parvovirus B19‑VP1 unique region on cardiac injury in naïve mice.

A unique region of human parvovirus B19 virus-VP1 (B19V–VP1u) has been linked to a variety of cardiac disorders. However, the precise role of B19V–VP1u in inducing cardiac injury remains unknown. The present study investigated the effects of B19V–VP1u and different regions of B19V–VP1u, including B19V–VP1uA (residues 1–60), B19V–VP1uB (residues 61–129), B19V–VP1uC (residues 130–195) and B19V–VP1uD (residues 196–227), on inducing cardiac injury in naïve mice by zymography, immunoblotting, H&E staining and cytokine immunoassay. A significantly higher MMP-9/MMP-2 ratio and increased levels of inflammatory cytokines, including IL-6 and IL-1β, were detected in the left ventricles of the mice injected with B19V-non-structural protein 1 (B19V-NS1) and B19V–VP1u, accompanied by increased expression levels of phosphorylated (p-)ERK and p-P38. Significantly upregulated expression levels of atrial natriuretic peptide (ANP), heart-type fatty acid-binding protein (H-FABP) and creatine kinase isoenzyme-MB (CK-MB), which are well-known cardiac injury markers, as well as increased infiltration of lymphocytes, were detected in the left ventricles of the mice injected with B19V–VP1, B19V-NS1 and B19V–VP1u. Moreover, a significantly higher MMP-9/MMP-2 ratio and increased levels of IL-6 and IL-1β were observed in the left ventricles of the mice injected with B19V–VP1u, B19V–VP1u-A, B19V–VP1u-B and B19V–VP1u-C, accompanied by upregulated p-ERK and p-P38 expression. Notably, significantly lower levels of IL-6 and IL-1β were observed in the left ventricles of the mice injected with B19V–VP1uD. Furthermore, significantly increased ANP, H-FABP and CK-MB expression levels were detected in the left ventricles of the mice injected with B19V–VP1u, B19V–VP1u-A and B19V–VP1u-B, along with enhanced infiltration of lymphocytes. Significantly higher serum IL-1β, IL-6, TNF-α and IFN-γ levels were also detected in the mice injected with B19V–VP1u, B19V–VP1u-A and B19V–VP1u-B. To the best of our knowledge, the findings of the present study were the first to demonstrate that the N-terminal region (residues 1–129) of B19V–VP1u induces an increase in the levels of cardiac injury markers, thus providing evidence for understanding the possible functional regions within B19V–VP1u.

Rapid detection of human heart-type fatty acid-binding protein in human plasma and blood using a colloidal gold-based lateral flow immunoassay.

The incidence of acute myocardial infarction (AMI) is currently increasing. Early detection is important for the treatment and prognosis of patients with AMI. Heart-type fatty acid-binding protein (H-FABP) may be used as an early marker of AMI due to its high sensitivity, specificity and prognostic value. Therefore, in the present study, H-FABP was used as a biomarker in a double-antibody sandwich method and colloidal gold-based lateral flow immunoassay to develop a rapid detection kit for H-FABP with a processing time of only 5 min. The sensitivity of the kit in plasma and whole blood was 1 ng/ml and this method had good specificity, exhibiting no cross-reaction with cardiac troponin I, myoglobin or creatine kinase-Mb. The kits had good shelf life and stability, as they were able to be stored at 40˚C for 30 days. A total of 12 clinical samples were collected for detection and the coincidence rate with the ELISA method was up to 91.67%. Therefore, the present study provided a simple, rapid and economical early-detection in-home testing kit.

Polymorphism of FABP3 gene and its effect on litter size and milk production of synthetic population bulgarian milk ewes

Aim. The purpose of this work was to study polymorphism of FABP3 (heart-type fatty acid binding protein) gene and its effect on litter size and milk production. The experiment included 30 ewes of Synthetic Population Bulgarian Milk breed from Institute of Animal Science – Kostinbrod. Methods. By PCR-RFLP method with endonuclease BseDI in SNP3 of FABP3 gene were detected two genotypes – GG and AG. Results. In SNP3 of FABP3 gene the frequency of allele G was 0.85 and the frequency of allele A was 0.15. The genotype GG was with frequency 0.70 and AG – with 0.30. Conclusions. In this study of ewes from SPBM breed, the presence of heterozygous genotype AG in SNP3 of the FABP3 was associated with increased litter size, while the presence of the homozygous genotype GG led to increased milk productivity during lactation.
 Keywords: sheep, FABP3 gene, litter size, milk production.

Heart-type fatty acid binding protein is related to severity and established cardiac biomarkers of heart failure.

To determine concentrations of heart-type fatty acid-binding protein (HFABP) in patients with heart failure with reduced ejection fraction (HFrEF) and its potential value for prognostic assessment. Circulating levels of HFABP were measured with an automated chemiluminescent immunoassay in 25 healthy volunteers and 60 HFrEF patients. Concentrations of HFABP were significantly increased in heart failure patients in comparison to healthy volunteers. HFABP levels were significantly correlated to New York Heart Association classes and to established biomarkers of cardiac dysfunction and remodeling (amino-terminal pro-B-type natriuretic peptide [NT-proBNP], fibroblast growth factor 23, and galectin-3). HFABP concentrations were also predictive of cardiovascular (CV) death and combination with NT-proBNP might be synergistic for risk assessment. HFABP levels are increased in HFrEF patients, related to adverse CV outcomes, and might assist physicians for patient's management.

AuPt nanocrystals/polydopamine supported on open-pored hollow carbon nanospheres for a dual-signaling electrochemical ratiometric immunosensor towards h-FABP detection

For early diagnosis and prevention of acute myocardial infarction (AMI), accurate and sensitive analysis of cardiac biomarkers by a single test has faced substantial challenge. A novel electrochemical immuno-sensing platform was built for untrasensitive assay of heart-type fatty acid-binding protein (h-FABP) via multi-signal output. This immunosensor utilized Au nanodendrites/chitosan-grafted-ferrocene (Au NDs/Chit-g-Fc) as the substrate and thionine-absorbed AuPt nanocrystals/polydopamine/open-pored hollow carbon spheres (Thi/AuPt/PDA/OHCSs) as the label material, producing two independent electrochemical signals from the Fc and Thi probes, respectively. For such assay of the target h-FABP in the immuno-sensing system, the ratios (IThi / IFc) between the double signals showed a broad dynamic range of 0.001–200.0 ng mL−1 and a low detection limit of 0.53 pg mL−1 (S/N = 3). This ratiometric sensor exerts a far-reaching influence on other biomarkers researches in practical applications.

Dynamics of Selected Biomarkers in Cerebrospinal Fluid During Complex Endovascular Aortic Repair – A Pilot Study

Ischemic spinal cord injury (SCI) is a serious complication of complex aortic repair. Prophylactic cerebrospinal fluid (CSF) drainage, used to decrease lumbar cerebrospinal fluid (CSF) pressure, enables monitoring of CSF biomarkers that may aid in detecting impending SCI. We hypothesized that biomarkers, previously evaluated in traumatic SCI and brain injury, would be altered in CSF over time following complex endovascular aortic repair (cEVAR). To examine if a chosen cohort of CSF biomarker correlates to SCI and warrants further research. A prospective observational study on patients undergoing cEVAR with extensive aortic coverage. Vital parameters and CSF samples were collected on ten occasions during 72 hours post-surgery. A panel of ten biomarkers were analyzed (Neurofilament Light Polypeptide (NFL), Tau, Glial Fibrillary Acidic Protein (GFAP), Soluble Amyloid Precursos Protein (APP) α and β, Amyloid β 38, 40 and 42 (Aβ38, 40 and 42), Chitinase-3-like protein 1 (CHI3LI or YKL-40), Heart-type fatty acid binding protein (H-FABP).). Nine patients (mean age 69, 7 males) were included. Median total aortic coverage was 68% [33, 98]. One patient died during the 30-day post-operative period. After an initial stable phase for the first few postoperative hours, most biomarkers showed an upward trend compared with baseline in all patients with >50% increase in value for NFL in 5/9 patients, in 7/9 patients for Tau and in 5/9 patients for GFAP. One patient developed spinal cord and supratentorial brain ischemia, confirmed with MRI. In this case, NF-L, GFAP and tau were markedly elevated compared with non-SCI patients (maximum increase compared with baseline in the SCI patient versus mean value of the maximal increase for all other patients: NF-L 367% vs 79%%, GFAP 95608% versus 3433%, tau 1020% vs 192%). This study suggests an increase in all ten studied CSF biomarkers after coverage of spinal arteries during endovascular aortic repair. However, the pilot study was not able to establish a specific correlation between spinal fluid biomarker elevation and clinical symptoms of SCI due to small sample size and event rate.

The prognostic impact of the serum heart-type fatty acid-binding protein level in patients with sepsis who were admitted to the non-surgical intensive-care unit.

Ongoing myocardial damage at the acme of the sepsis status has not been sufficiently evaluated. The clinical data of 160 sepsis patients who require intensive care and 127 outpatients with chronic heart failure (HF) were compared as a retrospective cohort study. Thereafter, the sepsis patients were divided into 3 groups according to the serum heart-type fatty acid-binding protein (H-FABP) quartiles [low H-FABP = Q1 (n = 39), middle H-FABP = Q2/Q3 (n = 81), and high H-FABP = Q4 group (n = 40)]. The H-FABP level was measured within 15 min of admission. The serum H-FABP levels in the sepsis patients [26.6 (9.3-79.0) ng/ml] were significantly higher than in the choric HF patients [6.6 (4.6-9.7) ng/ml]. A Kaplan-Meier curve showed that the survival rate of the high-H-FABP group was significantly lower than that of the middle- and low-H-FABP groups. The multivariate Cox regression analysis for the 365-day mortality showed that the high-H-FABP group (hazard ratio: 6.544, 95% confidence interval [CI] 2.026-21.140; p = 0.002) was an independent predictor of the 365-day mortality. The same trend in the prognostic impact was significantly (p = 0.015) observed in the cohort that had not been suffering from the cardiac disease before admission. The serum H-FABP level was an independent predictor of the 365-day mortality in the patients who were emergently hospitalized in the intensive-care unit due to sepsis. Ongoing myocardial damage was detected in the majority of patients with sepsis, suggesting that ongoing myocardial damage might be a candidate predictor of adverse outcomes in sepsis patients.

Electrochemical immunosensor development based on core-shell high-crystalline graphitic carbon nitride@carbon dots and Cd0.5Zn0.5S/d-Ti3C2Tx MXene composite for heart-type fatty acid-binding protein detection.

Acute myocardial infarction (AMI) is a significant health problem owing to its high mortality rate. Heart-type fatty acid-binding protein (h-FABP) is an important biomarker in the diagnosis of AMI. In this work, an electrochemical h-FABP immunosensor was developed based on Cd0.5Zn0.5S/d-Ti3C2Tx MXene (MXene: Transition metal carbide or nitride) composite as signal amplificator and core-shell high-crystalline graphitic carbon nitride@carbon dots (hc-g-C3N4@CDs) as electrochemical sensor platform. Firstly, a facile calcination technique was applied to the preparation of hc-g-C3N4@CDs and immobilization of primary antibody was performed on hc-g-C3N4@CDs surface. Then, the conjugation of the second antibody to Cd0.5Zn0.5S/d-Ti3C2Tx MXene was carried out by strong π-π and electrostatic interactions. The prepared electrochemical h-FABP immunosensor was characterized by transmission electron microscopy (TEM), scanning electron microscopy (SEM), x-ray diffraction (XRD) method, Fourier-transform infrared spectroscopy (FTIR), x-ray photoelectron spectroscopy (XPS), cyclic voltammetry (CV), and electrochemical impedance spectroscopy (EIS). The prepared electrochemical h-FABP immunosensor indicated a good sensitivity with detection limit (LOD) of 3.30fgmL-1 in the potential range +0.1 to +0.5V. Lastly, low-cost, satisfactory stable, and environmentally friendly immunosensor was presented for the diagnosis of acute myocardial infarction.

Ratiometric Fluorescent Lateral Flow Immunoassay for Point‐of‐Care Testing of Acute Myocardial Infarction

AbstractWe report the development of a highly sensitive ratiometric fluorescent lateral flow immunoassay (RFLFIA) strip for rapid and accurate detection of acute myocardial infarction biomarker, namely heart‐type fatty acid binding protein (H‐FABP). The RFLFIA strip works in terms of ratiometric change of fluorescence signal, arising from blending of fluorescence emitted by two composite nanostructures conjugated to capture and probe antibodies and inner filter effect of gold nanoparticles. In conjunction with using custom smartphone‐based analytical device and tonality analysis, quantitative detection of H‐FABP was achieved with a low limit of detection at 0.21 ng mL−1. The RFLFIA strip can generate a visually distinguishable green‐to‐red color change around the threshold concentration of H‐FABP (6.2 ng mL−1), thus allowing the semi‐quantitative diagnosis by the naked eye.

Ratiometric Fluorescent Lateral Flow Immunoassay for Point-of-Care Testing of Acute Myocardial Infarction.

We report the development of a highly sensitive ratiometric fluorescent lateral flow immunoassay (RFLFIA) strip for rapid and accurate detection of acute myocardial infarction biomarker, namely heart-type fatty acid binding protein (H-FABP). The RFLFIA strip works in terms of ratiometric change of fluorescence signal, arising from blending of fluorescence emitted by two composite nanostructures conjugated to capture and probe antibodies and inner filter effect of gold nanoparticles. In conjunction with using custom smartphone-based analytical device and tonality analysis, quantitative detection of H-FABP was achieved with a low limit of detection at 0.21 ng mL-1 . The RFLFIA strip can generate a visually distinguishable green-to-red color change around the threshold concentration of H-FABP (6.2 ng mL-1 ), thus allowing the semi-quantitative diagnosis by the naked eye.

Early myocardial damage (EMD) and valvular dysfunction after femur fracture in pigs

Musculoskeletal injuries are the most common reason for surgery in severely injured patients. In addition to direct cardiac damage after physical trauma, there is rising evidence that trauma induces secondary cardiac structural and functional damage. Previous research associates hip fractures with the appearance of coronary heart disease: As 25% of elderly patients developed a major adverse cardiac event after hip fracture. 20 male pigs underwent femur fracture with operative stabilization via nailing (unreamed, reamed, RIA I and a new RIA II; each group n = 5). Blood samples were collected 6 h after trauma and the concentration of troponin I and heart-type fatty acid binding protein (HFABP) as biomarkers for EMD were measured. At baseline and 6 h after trauma, transesophageal ECHO (TOE) was performed; and invasive arterial and left ventricular blood pressure were measured to evaluate the cardiac function after femur fracture. A systemic elevation of troponin I and HFABP indicate an early myocardial damage after femur fracture in pigs. Furthermore, various changes in systolic (ejection fraction and cardiac output) and diastolic (left ventricular end-diastolic pressure, mitral valve deceleration time and E/A ratio) parameters illustrate the functional impairment of the heart. These findings were accompanied by the development of valvular dysfunction (pulmonary and tricuspid valve). To the best of our knowledge, we described for the first time the development of functional impairment of the heart in the context of EMD after long bone fracture in pigs. Next to troponin and HFABP elevation, alterations in the systolic and diastolic function occurred and were accompanied by pulmonary and tricuspid valvular insufficiency. Regarding EMD, none of the fracture stabilization techniques (unreamed nailing, reaming, RIA I and RIA II) was superior.

Promising Novel Biomarkers in Cardiovascular Diseases

Cardiovascular diseases remain the most common causes of death globally, according to the World Health Organization. In recent years, a great number of biomarkers have been investigated, whereas only some have gained value in the diagnosis, prognosis, and risk stratification of different cardiovascular illnesses. As numerous studies have investigated the diagnostic yield of novel biomarkers in various disease entities every year, this review aims to provide an overview of the current status of four promising representatives. In particular, this manuscript refers to soluble suppression of tumorigenicity 2 (sST2), heart-type fatty acid binding protein (H-FABP), growth differentiation factor (GDF-15) and soluble urokinase-type plasminogen activator receptor (suPAR). These markers are of special interest as they are thought to provide an accurate estimate of cardiovascular risk in certain patient populations, especially those with pre-existing diseases, such as obesity or diabetes mellitus. We sought to give an overview of their function, individual diagnostic and predictive value and determination in the laboratory. A review of the literature regarding the aforementioned cardiovascular biomarkers yielded manifold results with respect to their individual diagnostic and prognostic value. Yet, the clinical relevance of these findings remains unclear, warranting further studies to identify their optimal use in clinical routine.

Value of combined detection of biomarkers in early diagnosis and prognosis of patients with septic myocardial injury

To investigate the value of combined detection of biomarkers in early diagnosis and prognosis of patients with septic myocardial injury. The clinical data of 103 patients with sepsis admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology from October 2018 to January 2021 were enrolled. According to the cardiac troponin I (cTnI) at admission of ICU, they were divided into septic myocardial injury group (cTnI ≥ 0.15 μg/L) and non-septic myocardial injury group (cTnI < 0.15 μg/L). The serum levels of heart-type fatty acid-binding protein (H-FABP), procalcitonin (PCT), C-reactive protein (CRP), MB isoenzyme of creatine kinase (CK-MB), cTnI and N-terminal pro-brain natriuretic peptide (NT-proBNP) within 6 hours after ICU admission and the worst value of acute physiology and chronic health evaluation II (APACHE II) score within 24 hours after ICU admission in 103 patients was recorded as well as the 28-day prognosis of patient with septic myocardial injury. Spearman correlation analysis was used to analyze the correlation of each index; receiver operating characteristic curve (ROC curve) was drawn, and the area under ROC curve (AUC) was calculated to analyze the early diagnosis and prognostic value of each index and APACHE II score alone or combined detection in patients with septic myocardial injury. (1) Among 103 patients with sepsis, 58 patients were complicated with myocardial injury and 45 patients were not complicated with myocardial injury. The serum levels of PCT, CRP, NT-proBNP, CK-MB, cTnI, H-FABP and APACHE II score in patients with septic myocardial injury were significantly higher than those in patients without septic myocardial injury [PCT (μg/L): 3.46±1.35 vs. 1.89±0.43, CRP (mg/L): 81.1±26.8 vs. 65.3±19.1, NT-proBNP (U/L): 8 261.4±2 346.9 vs. 6 120.2±1 809.6, CK-MB (U/L): 15.89±6.25 vs. 12.14±4.24, cTnI (μg/L): 1.50 (0.91, 2.21) vs. 0.18 (0.16, 0.19), H-FABP (μg/L): 26.45±8.24 vs. 12.82±5.73, APACHE II score: 24.0 (18.0, 29.0) vs. 16.0 (14.0, 18.0), all P < 0.01]. Spearman correlation analysis showed that PCT, CRP and APACHE II scores were positively correlated with NT-proBNP, CK-MB, cTnI and H-FABP. ROC curve analysis showed that H-FABP in the diagnosis of septic myocardial injury (AUC = 0.916) was superior to NT-proBNP (AUC = 0.756) and CK-MB (AUC = 0.675); the AUC of NT-proBNP and CK-MB combined with H-FABP was 0.921, the sensitivity was 82.1%, and the specificity was 88.2%. (2) Twenty-three patients survived in 28 days, and 35 died. The levels of serum PCT, CRP, NT-proBNP, CK-MB, cTnI, H-FABP and APACHE II score in death group were significantly higher than those in survival group [PCT (μg/L): 3.86±1.27 vs. 2.84±1.24, CRP (mg/L): 92.3 (65.0, 101.7) vs. 74.3 (65.7, 79.8), NT-proBNP (ng/L): 9 106.4±2 013.9 vs. 6 975.5±2 266.7, CK-MB (U/L): 17.90±6.49 vs. 12.82±4.46, cTnI (μg/L): 2.11±0.86 vs. 1.12±0.44, H-FABP (μg/L): 30.08±7.90 vs. 20.93±5.14, APACHE II score: 25.0 (20.0, 30.0) vs. 19.0 (17.0, 24.0), all P < 0.01]. ROC curve analysis showed that H-FABP in evaluating 28-day death of patients with septic myocardial injury (AUC = 0.839) was superior to PCT (AUC = 0.707), CRP (AUC = 0.716), NT-proBNP (AUC = 0.761), CK-MB (AUC = 0.733), cTnI (AUC = 0.824) and APACHE II score (AUC = 0.724); the AUC of NT-proBNP and cTnI combined with H-FABP was 0.888, the sensitivity was 91.4%, and the specificity was 82.6%. H-FABP plays an important role in the early diagnosis and prognosis of septic myocardial injury. Early combined detection of NT-proBNP, CK-MB and H-FABP can significantly improve the diagnostic ability of septic myocardial injury, and NT-proBNP and cTnI combined with H-FABP can significantly improve the ability to predict the adverse prognosis of sepsis myocardial injury.

Skin Ultrastructure and the Changes of HIF-2α, H-FABP Expression in the Myocardium of Electric Shock Death Rats.

Objective To observe the skin ultrastructure change of electric shock death rats and to test the expression changes of hypoxia-inducible factor-2α （HIF-2α） and heart type-fatty acid-binding protein （H-FABP） of myocardial cells, in order to provide basis for forensic identification of electric shock death. Methods The electric shock model of rats was established. The 72 rats were randomly divided into control group, electric shock death group and postmortem electric shock group. Each group was divided into three subgroups, immediate （0 min）, 30 min and 60 min after death. The skin changes of rats were observed by HE staining, the changes of skin ultrastructure were observed by scanning electron microscopy, and the expression of HIF-2α and H-FABP in rats myocardium was tested by immunohistochemical staining. Results The skin in the electric shock death group and postmortem electric shock group had no significant difference through the naked eye or by HE staining. Under the scanning electron microscope, a large number of cellular debris, cells with unclear boundaries, withered cracks, circular or elliptical holes scattered on the cell surface and irregular edges were observed. A large number of spherical foreign body particles were observed. Compared with the control group, the expression of HIF-2α in all electric shock death subgroups increased, reaching the peak immediately after death. In the postmortem electric shock group, HIF-2α expression only increased immediately after death, but was lower than that of electric shock death group （P<0.05）. Compared with the control group, the expression of H-FABP in all subgroups of electric shock death group and postmortem electric shock group significantly decreased. The expression of H-FABP in all subgroups of electric shock death group was lower than that of the postmortem electric shock group （P<0.05）. Conclusion Electric shock can increase HIF-2α expression and decrease H-FABP expression in the myocardium, which may be of forensic significance for the determination of electric shock death and identification of antemortem and postmortem electric shock.

Levosimendan Versus Milrinone and Release of Myocardial Biomarkers After Pediatric Cardiac Surgery: Post Hoc Analysis of Clinical Trial Data.

We compared the effect of two inodilators, levosimendan and milrinone, on the plasma levels of myocardial injury biomarkers, that is, high-sensitivity troponin T and heart-type fatty acid binding protein, and on N-terminal prohormone of brain natriuretic peptide as a biomarker of ventricular function. We hypothesized that levosimendan could attenuate the degree of myocardial injury when compared with milrinone. A post hoc, nonprespecified exploratory secondary analysis of the Milrinone versus Levosimendan-1 trial (ClinicalTrials.gov Identifier: NCT02232399). Two pediatric tertiary university hospitals. Infants 1-12 months old, diagnosed with ventricular septal defect, complete atrioventricular septal defect, or Tetralogy of Fallot undergoing corrective surgery with cardiopulmonary bypass. Seventy patients received a loading dose of either levosimendan or milrinone at the start of cardiopulmonary bypass followed by an infusion of the respective drug, which continued for 26 hours. Plasma levels of the three cardiac biomarkers were measured prior to the initiation of cardiopulmonary bypass and 2, 6, and 24 hours after weaning from cardiopulmonary bypass. In both groups, the levels of high-sensitivity troponin T and heart-type fatty acid binding protein were highest at 2 hours post cardiopulmonary bypass, whereas the highest level of N-terminal prohormone of brain natriuretic peptide occurred at 24 hours post cardiopulmonary bypass. There was no significant difference in the biomarkers' plasma levels between the study groups over time. Neither was there a significant difference in the postoperative peak plasma levels of the cardiac biomarkers. In this post hoc analysis of the MiLe-1 trial, there was no demonstrable difference in the postoperative cardiac biomarker profile of myocardial injury and ventricular function when comparing infants managed in the perioperative period with levosimendan versus milrinone.

Diagnostic Value of Heart-type Fatty Acid Binding Protein in Group of Patients with NSTEMI at the Time of Application for Medical Care

The relevance of the early detection of myocardial necrosis is due to the difficulties of differential diagnosis in the first hours of the development of acute coronary syndrome. Therefore, the doctors of the first contact, as before, are interested in an early cardiac marker and the presence of tests based on it. Heart fatty acid binding protein (h-FABP) is a cardiac marker that increases in the blood to diagnostic values after just one hour from the beginning of clinical manifestations.&#x0D; The objective: to determine the diagnostic value of heart fatty acid binding protein in group of patients with NSTEMI.&#x0D; Materials and methods. We examined 280 patients with STEMI, 91 patients with NSTEMI, 76 with stable angina pectoris. Blood samples were taken from all patients at the first contact to determine troponin I, a heart fatty acid binding protein and CPK-MB. Patients with NSTEMI were divided into three subgroups: the first – up to 3 hours from the onset of symptoms, the second – from 3 to 6, the third from 6 to 12. The level of heart fatty acid binding protein in plasma was determined by enzyme immunoassay.&#x0D; Results. The early detection of AMI in people visiting primary care doctors with chest pain continues to be a challenge. Undoubtedly, cardiac troponins are the “gold standard” for the diagnosis of AMI, but early detection of these can give a negative result. The results of the studies show a high diagnostic efficacy of h-FABP in the early diagnosis of AMI, and it is superior in sensitivity (in the first hours from the onset of the disease) to cardiac troponins. So, for example, in the subgroup of patients with the onset of symptom manifestation up to 3 hours for h-FABP with a cut-off &gt;0,48 ng/ml, the sensitivity was 92.7 % and specificity was 97,3 % (AUC=0,99; 95 % CI AUC 0,942–0,998). In the same subgroup, troponin I had a specificity of 22,0 %, with cut off &gt;0,84 ng/ml (AUC=0,71; 95 % CI AUC 0,615–0,787).&#x0D; Conclusions. The level of cardiac protein that binds fatty acids is significantly increased in patients with acute myocardial infarction compared with stable coronary heart disease.