Serum Heart-type Fatty Acid-binding Protein Levels Research Articles

Biomarker array for prediction of acute kidney injury after percutaneous coronary intervention for patients who had acute ST segment elevation myocardial infarction

Acute kidney injury (AKI) is a common complication after Percutaneous Coronary Intervention (PCI) for ST segment elevation myocardial infarction (STEMI) and is associated with poor outcomes. AKI is diagnosed by the dynamic change of serum Cr, but it could not predict AKI. This study aimed to evaluate a biomarker array that may fulfill this shortage. Setting: Cardiology Department, Tanta University Hospital. Design: Prospective interventional study included 280 acute STEMI patients who underwent emergency PCI. Serial samples of blood and urine were obtained at the time of admission to the hospital (T0) and PCI unit (T1) and at 12 h and 72 h (T12 and T72) after coronary revascularization to estimate levels of serum Cr, creatine phosphokinase, and heart-type fatty acid-binding protein (H-FABP) and calculation of neutrophil/lymphocyte ratio (NLR) and urinary liver-type FABP (L-FABP). AKI was diagnosed according to the recommendations of the European Renal Best Practice as the times of increased serum Cr concerning baseline level. 85 patients developed AKI. Regression analyses defined a high NLR ratio in the T0 sample as the most significant predictor for early AKI diagnosed at T1 time, while high NLR and serum H-FABP levels in T1 samples as the significant predictors for AKI defined at T12 time. However, high urinary L-FABP levels in T12 samples and high NLR are significant predictors for AKI at T72 time. Combined estimations of serum H-FABP and urinary L-FABP with the calculation of NLR could predict the oncoming AKI and discriminate its pathogenesis. The study protocol was approved by the Local Ethical Committee at Tanta Faculty of Medicine by approval number: 35327/3/22. For blindness purposes, the authors will be blinded about the laboratory results till the end of 72 h after revascularization and the clinical pathologist will be blinded about the indication for the requested investigations.

Effect of modified Wenyang Buxin decoction and routine therapy on cardiac function and serum levels of H-FABP, cTnI and Ang-2 in chronic heart failure patients

Purpose: To investigate the effect of modified Wenyang Buxin decoction and routine therapy on cardiac function and serum levels of heart-type fatty acid binding protein (H-FABP), cardiac troponin-1 (cTnI) and angiopoietin-2 (Ang-2) in chronic heart failure (CHF) patients.Methods: A total of 120 CHF patients admitted to Zhejiang Province Rongjun Hospital (from January2019 - January 2020) were selected for this study. They were randomly but equally distributed into groups A and B. All patients were given routine therapy such as diuretic treatment and detumescence, while those in group A received 150 mL of modified Wenyang Buxin decoction daily, in addition to routine therapy. At 2 months after therapy, cardiac function indices, serum H-FABP, cTnI and Ang-2 levels, hemorheology indices, traditional Chinese medicine (TCM) syndrome scores, and Chinese questionnaire of quality of life in cardiovascular patients (CQQC) scores of the two groups were evaluated.Results: After therapy, cardiac function indices, serum H-FABP, cTnI and Ang-2 levels, hemorheology indices as well as TCM syndrome score and CQQC score were significantly improved in group A, when compared with corresponding values in group B (p < 0.05).Conclusion: Modified Wenyang Buxin decoction and routine therapy improves serum biomarker levels, cardiac function and quality of life, and relieves clinical symptoms of CHF in patients. Therefore, this treatment approach may be useful in the management of CHF patients.

Heart-Type Fatty Acid Binding Protein, Cardiovascular Outcomes, and Death: Findings From the German CKD Cohort Study

Heart-type fatty acid binding protein (H-FABP) is a biomarker that has been shown to provide long-term prognostic information in patients with coronary artery disease independently of high-sensitivity troponin T (hs-TNT). We examined the independent associations of H-FABP with cardiovascular outcomes in patients with chronic kidney disease (CKD). Prospective cohort study. 4,951 patients enrolled in the German Chronic Kidney Disease (GCKD) study with an estimated glomerular filtration rate of 30-60 mL/min/1.73 m2 or overt proteinuria (urinary albumin-creatinine ratio > 300 mg/g or equivalent). Serum levels of H-FABP and hs-TNT were measured at study entry. Noncardiovascular (non-CV) death, CV death, combined major adverse CV events (MACE), and hospitalization for congestive heart failure (CHF). Hazard ratios (HRs) for associations of H-FABP and hs-TNT with outcomes were estimated using Cox regression analyses adjusted for established risk factors. During a maximum follow-up of 6.5 years, 579 non-CV deaths, 190 CV deaths, 522 MACE, and 381 CHF hospitalizations were observed. In Cox regression analyses adjusted for established risk factors, H-FABP was associated with all 4 outcomes, albeit with lower HRs than those found for hs-TNT. After further adjustment for hs-TNT levels, H-FABP was found to be associated with non-CV death (HR, 1.57 [95% CI, 1.14-2.18]) and MACE (HR, 1.40 [95% CI, 1.02-1.92]) but with neither CV death (HR, 1.64 [95% CI, 0.90-2.99]) nor CHF hospitalizations (HR, 1.02 [95% CI, 0.70-1.49]). Single-point measurements of H-FABP and hs-TNT. Uncertain generalizability to non-European populations. In this large cohort of patients with CKD, H-FABP was associated with non-CV death and MACE, even after adjustment for hs-TNT. Whether measurement of H-FABP improves cardiovascular disease risk prediction in these patients warrants further studies.

Relation of serum heart type fatty acid binding protein to left ventricular diastolic dysfunction in patients with type 2 diabetes and early diabetic kidney disease

AimsWe aimed to investigate the serum level of heart type fatty acid binding protein (H-FABP) and its relation to left ventricular (LV) diastolic dysfunction in patients with type 2 diabetes (T2DM) and early diabetic kidney disease (DKD). MethodsThis study was conducted on 100 T2DM patients divided into 50 patients with early DKD and 50 patients without DKD. Doppler echocardiography was used to assess LV function and serum H-FABP levels were measured using ELISA technique. Results78% of patients with DKD and 12% of patients without DKD had LV diastolic dysfunction. Among patients with DKD, those with diastolic dysfunction had significantly higher urinary albumin to creatinine ratio (UACR) (p = 0.041). H-FABP levels were significantly higher in patients with DKD (p˂0.001) and it had significant positive correlation with UACR (p = 0.009). No significant difference was found regarding serum H-FABP levels between patients with normal LV function and those with diastolic dysfunction in both study groups. ConclusionDiastolic dysfunction is a common finding among patients with T2DM. UACR, but not serum H-FABP, is significantly associated with diastolic dysfunction in patients with early DKD. Serum H-FABP level is significantly higher in early DKD and positively correlated with the level of albuminuria.

The Relationship with Serum Heart Type Fatty Acid Binding Protein and Subclinical Atherosclerosis in Patients with Hypothyroidism

Aim: To investigate the variability of Carotid intima-media thickness (CIMT) and the relationship between CIMT and serum Hearttype fatty acid binding protein (H-FABP) levels in patients with overt and subclinical hypothyroidism. We also aimed to evaluate the effect of levothyroxine treatment on these markers. Material and Methods: 40 patients with overt hypothyroidism (OH), 40 patients with subclinical hypothyroidism (SH) and 30 healthy individuals as control group were evaluated according to serum lipid and thyroid hormone panels, serum H-FABP levels and CIMT measurements. Serum H-FABP levels and CIMT of the patients in group OH were also evaluated following 6-months levothyroxine replacement treatment. Results: The levels of serum total cholesterol, LDL cholesterol and H-FABP in group OH were significantly higher (p<0.05). CIMT in group OH was also significantly higher than other groups (p<0.05). There was an insignificant slight positive correlation between serum H-FABP and CIMT. The values of serum H-FABP levels and CIMT measurements after levothyroxine treatment significantly decreased in comparison with pre-treatment period (p<0.05). Conclusion: The increased CIMT and H-FABP levels in overt hypothyroidism might be used as an indicator in determining subclinical atherosclerosis. Levothyroxine treatment might protect the patients with overt hypothyroidism in terms of cardiovascular risk by decreasing CIMT and serum H-FABP levels.

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.

Serum Level of Heart Type Fatty Acid Binding Protein Before and after Treatment of Congestive Heart Failure in Children

Background: Heart failure (HF) in children is a clinical and pathophysiological syndrome that results from ventricular dysfunction, volume or pressure overload, either alone or in combination. This study aimed to estimate serum level of H-FABP before and after treatment of congestive heart failure, and correlate its level with severity of the disease. Patients and methods: The study was cohort control study. It included 30 infants and children; their ages ranged from two months to four years with heart failure diagnosed clinically and were admitted to Cardiology Unit of Pediatric Department, at Zagazig University Hospitals during the period from November 2017 to April 2018. They were divided into four groups, first group aged (2-12 month), second group (13-24 m), third group (25-36 m) and fourth group (37-48 m). Echocardiographic assessment of the heart was done using conventional Doppler echocardiography. Serum heart type fatty acid binding protein (H-FABP) level (estimated on patient admission and 1 week after treatment) was determined by quantitative sandwich enzyme linked immunosorbent assay (ELISA) technique. Results: There was a significant difference in the serum level of H-FABP in our patients before treatment (2.156 ± 1.156 ng/ml) compared with after treatment (0.882 ± 0.716 ng/ml). There was a significant positive correlation between serum H-FABP level and Ross classification. Conclusion: H-FABP may be used as diagnostic and prognostic predictor of adverse outcome in children with heart failure.

Serum Level of Heart Type Fatty Acid Binding Protein Before and after Treatment of Congestive Heart Failure in Children

Background: Heart failure (HF) in children is a clinical and pathophysiological syndrome that results from ventricular dysfunction, volume or pressure overload, either alone or in combination. This study aimed to estimate serum level of H-FABP before and after treatment of congestive heart failure, and correlate its level with severity of the disease. Patients and methods: The study was cohort control study. It included 30 infants and children; their ages ranged from two months to four years with heart failure diagnosed clinically and were admitted to Cardiology Unit of Pediatric Department, at Zagazig University Hospitals during the period from November 2017 to April 2018. They were divided into four groups, first group aged (2-12 month), second group (13-24 m), third group (25-36 m) and fourth group (37-48 m). Echocardiographic assessment of the heart was done using conventional Doppler echocardiography. Serum heart type fatty acid binding protein (H-FABP) level (estimated on patient admission and 1 week after treatment) was determined by quantitative sandwich enzyme linked immunosorbent assay (ELISA) technique. Results: There was a significant difference in the serum level of H-FABP in our patients before treatment (2.156 ± 1.156 ng/ml) compared with after treatment (0.882 ± 0.716 ng/ml). There was a significant positive correlation between serum H-FABP level and Ross classification. Conclusion: H-FABP may be used as diagnostic and prognostic predictor of adverse outcome in children with heart failure.

[Diagnostic value of heart-type fatty acid-binding protein combined with echocardiography in sepsis with cardiac insufficiency].

To observe the value of heart-type fatty acid-binding protein (H-FABP) and echocardiographic indexes in the diagnosis of cardiac insufficiency in sepsis. A prospective observational study was conducted. Eighty patients with sepsis admitted to the department of critical care medicine of the First Affiliated Hospital of Medical College of Shihezi University from October 2016 to January 2018 were enrolled. General clinical data such as gender, age, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA) score, hospitalization time and 28-day mortality were recorded. Echocardiographic indexes at 1, 3, 7, 10 days after diagnosis, and white blood cell (WBC), neutrophilic granulocyte percentage (N%), N-terminal pro-brain natriuretic peptide (NT-proBNP), serum H-FABP level were recorded. Sepsis patients were divided into normal cardiac function group (n = 30) and cardiac insufficiency group (n = 50) according to cardiac function, the differences of echocardiographic indexes and cardiac markers between the two groups at different time points were compared. Logistic regression was used to screen out cardiac ultrasound indexes and cardiac markers that affect the occurrence of cardiac dysfunction in sepsis patients, and then receiver operating characteristic (ROC) curve analysis was performed. Comparing the general data of the two groups, only the SOFA score of the cardiac insufficiency group was significantly higher than that of the normal cardiac function group (6.12±4.09 vs. 4.57±2.45, P < 0.05). N% and H-FABP in cardiac insufficiency group were higher than those in normal cardiac function group at the same time (N%: F = 6.973, P = 0.010; H-FABP: F = 17.303, P = 0.000). Without considering the time factor, there were significant differences in left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), stroke volume (SV), cardiac output (CO), left ventricular fractional shortening (LVFS), E-point of septal separation (EPSS), isovolumic relaxation time (IVRT), E peak deceleration time (EDT), A peak duration (Ad), left ventricular systolic pulmonary vein velocity (S), blood flow velocity of pulmonary vein in early left ventricular diastolic period (D), tricuspid orifice early diastolic blood flow velocity (E'), tricuspid orifice late diastolic blood flow velocity (A'), systolic velocities of the right ventricular free wall tricuspid annulus (Sm), and pulmonary valve annulus blood flow velocity (PVBV) between the two groups. ROC curve analysis of cardiac ultrasound indicators and cardiac markers screened by Logistic regression showed that the area under ROC curve (AUC) and the positive and negative predictive values were: LVEDV was 0.636, 77.30%, 56.03%; SV was 0.779, 88.82%, 71.19%; LVEF was 0.753, 92.12%, 55.21%; CO was 0.754, 88.82%, 77.19%; LVFS was 0.728, 81.25%, 66.99%; EPSS was 0.663, 96.99%, 51.56%; IVRT was 0.775, 86.97%, 73.55%; A' was 0.908, 96.58%, 89.60%; Sm was 0.738, 93.37%, 56.77%; H-FABP was 0.673, 80.26%, 57.25%, respectively. H-FABP was tested in parallel with LVEDV, SV, LVEF, CO, LVFS, EPSS, IVRT, A', Sm, and the positive predictive values were higher than the single diagnostic test (85.45%, 93.91%, 96.72%, 94.74%, 89.43%, 98.00%, 92.00%, 99.42%, 93.60%, respectively), the negative predictive values were lower than the single diagnostic test (50.89%, 57.93%, 49.15%, 58.18%, 57.05%, 45.74%, 57.92%, 64.13%, 47.78%, respectively). Cardiac ultrasound indicators LVEDV, SV, LVEF, CO, LVFS, EPSS, IVRT, A', and Sm combined with H-FABP are of certain value in the diagnosis of sepsis-associated heart dysfunction.

Clinical significance of serum level changes of heart-type fatty acid-binding protein and S-100B protein in elderly patients with chronic heart failure

Objective To investigate serum level changes of heart-type fatty acid-binding protein(H-FABP)and S100 calcium-binding protein B(S-100B)protein in elderly patients with chronic heart failure and their clinical significance. Methods A total of 160 patients with chronic heart failure treated at our hospital were recruited, and 80 healthy individuals receiving regular check-ups were enrolled as normal controls.Serum levels of H-FABP and S-100B and cardiac function index scores were compared between patients with different cardiac function grades.Correlations of serum H-FABP and S-100B levels with N-terminal pro-B-type natrlure tiepeptide(NT-proBNP)and with cardiac function index scores in heart failure patients were analyzed.The sensitivity, specificity and accuracy of serum H-FABP, S-100B and NT-proBNP for heart failure detection were compared. Results Serum levels of H-FABP, S-100B and NT-proBNP in elderly patients with chronic heart failure were elevated with increased cardiac function grading(F=9.823, 11.573 and 13.056, P=0.013, 0.000 and 0.000), and serum levels of H-FABP, S-100B and NT-proBNP were higher in elderly patients with heart failure than in the control group(P<0.05). Serum levels of H-FABP and S-100B were positively correlated with serum NT-proBNP levels, cardiac function grading and left ventricular end-diastolic diameter(LVEDd)(r=0.527, 0.510 and 0.487, P=0.008, 0.003 and 0.002; r=0.604, 0.496 and 0.533, P=0.006, 0.005 and 0.003), and were negatively correlated with left ventricular ejection fraction(LVEF)(r=-0.536 and-0.528, P=0.005 and 0.008). The sensitivity, specificity and accuracy of serum H-FABP combined with S-100B for heart failure detection were 93.2%, 91.6% and 95.7%, respectively. Conclusions Serum levels of H-FABP and S-100B are high in elderly patients with heart failure, and they are correlated with serum NT-proBNP levels, cardiac function grading and LVEDd.H-FABP combined with S-100B has a high positive rate for heart failure detection. Key words: Heart failure; Fatty acid-binding proteins; Calcium-binding proteins

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.

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.

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.

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, a marker of myocardial ischemia in children with epilepsy

To evaluate ictal serum levels of heart type fatty acid binding protein (H-FABP) in children with intractable epilepsy as a marker of cardiac ischemia in comparison to their levels in the interictal period and that of controls. The study included 23 seizure episodes recorded in 14 patients with intractable seizures. Serum levels of H-FABP in the ictal and interictal periods were done as well as simultaneous electrocardiogram, Holter and video electroencephalography recordings with evaluation of changes in the heart rate (HR), and HR variability parameters. Levels of H-FABP were higher in the patients' group whether in the ictal or interictal periods compared to the control group. However, levels were not significantly different in the ictal period compared to the interictal one. Ictal tachycardia was recorded in 95% and bradycardia in 5% of the studied seizures episodes. Premature atrial and ventricular contractions were recorded in the 1 st postictal hour of 8.7% and 30.4% of the recorded seizures, respectively. Interictal values showed significant increase minutes before the onset of the seizures and remained high 2 hours postictally. All time domain HR variability parameters were lower in the patients' group. Our results showed significant increase in the serum levels of H-FABP in our patients' group, which might suggest a degree of myocardial ischemia even in asymptomatic patients. Though bradycardia, prolonged QTc and arrhythmic changes were reported in few cases, the importance of the results warrants studying those changes at least in patients with refractory seizures.

Serum Level of Heart-Type Fatty Acid Binding Protein (H-FABP) Before and After Treatment of Congestive Heart Failure in Children.

Remodeling of the heart following injury affects the morbidity and mortality in children presented with heart failure (HF). Heart-type fatty acid binding protein (H-FABP) is a novel biomarker that could be of help to predict the prognosis and risk stratification in those children. We aimed to evaluate the diagnostic and prognostic value of H-FABP in children with heart failure before and after treatment. The study was conducted as a prospective cohort study. It included 30 children with HF as a patient group and 20 healthy children matched for age and sex as a control group. Echocardiographic assessment of the heart was done using conventional Doppler echocardiography. Serum levels of (H-FABP) were measured using enzyme-linked immunosorbent assay before and after treatment of HF. All patients were observed during follow-up period of 3months. There was a significant difference in the serum level of H-FABP in our patients before treatment (5.278±3.253ng/ml) compared with after treatment (2.089±0.160ng/ml) with significant difference compared with the control group. There was a significant increase in the serum level of H-FABP with increase in the severity of heart failure according to Ross classification. Significant increase in the H-FABP was associated with adverse outcome. Serum levels of H-FABP strongly correlated with clinical and echocardiographic assessment of LV performance of children with HF, and its levels significantly increased in children with adverse outcome suggesting its value as a useful diagnostic and prognostic predictor (with high sensitivity and specificity).

Circulating heart-type fatty acid-binding protein levels predict ventricular fibrillation in Brugada syndrome

BackgroundThe association between ongoing myocardial damage and outcomes in patients with Brugada syndrome who had received an implantable cardioverter-defibrillator (ICD) is unclear. MethodsConsecutive patients with Brugada syndrome (n=31, 50±13 years) who had received an ICD were prospectively enrolled. Minor myocardial membrane injury [heart-type fatty acid-binding protein (H-FABP) >2.4ng/mL] and myofibrillar injury (troponin T >0.005ng/mL) were defined using receiver operating characteristic curves. Patients were followed for a median period of 5 years to an endpoint of appropriate ICD shock. ResultsMyocardial membrane injury (29%) and myofibrillar injury (26%) were similarly prevalent among patients with Brugada syndrome who had received ICDs. Appropriate ICD shocks occurred in 19% of patients during the follow-up period. Multivariate Cox regression analysis showed that serum H-FABP level >2.4ng/mL, but not troponin T level, was an independent prognostic factor for appropriate ICD shock due to ventricular fibrillation [hazard ratio (HR) 25.2, 95% confidence interval (CI) 1.33–1686, p=0.03]. ConclusionsEvaluating myocardial damage using H-FABP may be a promising tool for predicting ventricular arrhythmia in patients with Brugada syndrome who have received ICDs.

Diabetic Patients Have Increased Perioperative Cardiac Risk in Heart-Type Fatty Acid-Binding Protein-Based Assessment

Objective: To test the potential role of heart-type fatty acid-binding protein (H-FABP) in detecting increased perioperative cardiac risk in comparison with cardiac troponin I (cTnI) in the early postoperative period. Subjects and Methods: Sixty-seven patients who had clinical risk factors and underwent elective intermediate - or high-risk noncardiac surgery were included in this study. Serum specimens were analyzed for H-FABP and cTnI levels before and at 8 h after surgery. None of the patients had chest pain; 27 had a history of ischemic heart disease, 3 of heart failure, 5 of cerebrovascular diseases, 40 of diabetes and 46 of hypertension. Results: The mean duration of the operations was 2.33 ± 1.27 h (range 1-6). In the postoperative period, 27 (40.3%) patients had increased H-FABP levels (≥7.5 ng/ml); the median preoperative serum H-FABP level was 0.13 ng/ml (<0.1-5.9) and the median postoperative H-FABP level was 6.86 ng/ml (<0.1-13.7). Only 1 (1.5%) patient had cTnI >0.1 µg/l during the postoperative period. Correlation analysis revealed that the presence of diabetes was associated with an increased H-FABP level (r = 0.30, p = 0.01). Of the 27 patients with H-FABP ≥7.5 ng/ml, 21 (87%) had diabetes. There was no significant correlation with other clinical risk factors, type or duration of surgery. Conclusion: The H-FABP levels significantly increased in the postoperative period. Most patients with increased postoperative H-FABP levels were diabetic. High H-FABP levels could alert clinicians to increased perioperative cardiovascular risk and could prevent underdiagnosis, especially in diabetic patients.

Serum Myeloperoxidase Level Is Associated with Heart-Type Fatty Acid-Binding Protein but Not Troponin T in Patients with Chronic Heart Failure

Objective: Our aim was to investigate the possible relationship between myeloperoxidase (MPO) and myocardial damage markers such as heart-type fatty acid-binding protein (H-FABP) and troponin T (TnT) in patients with chronic heart failure (HF). Materials and Methods: Forty-two consecutive patients (age range: 27-80 years) with chronic HF were enrolled in the study. Serum H-FABP, TnT and MPO levels were measured. Routine biochemical and clinical parameters were recorded. Echocardiographic examinations were performed on all patients. A linear regression analysis was performed to determine the correlates of serum H-FABP. Results: The MPO, H-FABP and TnT levels were 255 ± 227, 60.6 ± 48.5 and 0.07 ± 0.15 ng/ml, respectively. In multiple linear regression analysis, age (β = -0.36, p = 0.006), creatinine level (β = 0.3, p = 0.024) and serum MPO level (β = 0.41, p = 0.009) were significant determinants of H-FABP levels. Bivariate predictors were not significantly associated with TnT levels in linear regression analyses. Conclusions: The MPO was significantly associated with serum H-FABP levels but not with TnT.