J Korean Med Sci.  2011 Jan;26(1):47-52. 10.3346/jkms.2011.26.1.47.

Heart-type Fatty Acid Binding Protein as an Adjunct to Cardiac Troponin-I for the Diagnosis of Myocardial Infarction

• Kim KS
• Lee HJ
• Kim K
• Jo YH
• Kim TY
• Lee JH
• Rhee JE
• Suh GJ
• Kim MR
• Lee CC
• Singer AJ

• KMID: 1777975
• DOI: http://doi.org/10.3346/jkms.2011.26.1.47

Abstract

We hypothesized that when used in combination with cardiac troponins, heart-type fatty acid binding protein (H-FABP) would have greater diagnostic value than conventional markers for the early diagnosis of myocardial infarction (MI). Patients with typical chest pain at a single emergency department were consecutively enrolled. Initial blood samples were drawn for H-FABP, myoglobin, creatine kinase isoenzyme MB (CK-MB), and cardiac troponin-I (cTnI) measurements. MI was defined by serial cTnI measurements. To evaluate the adjunctive role of biochemical markers, we derived and compared logistic regression models predicting MI in terms of their discrimination (area under the receiver operating characteristics curve, AUC) and overall fit (Bayesian information criterion, BIC). Seventy-six of 170 patients were diagnosed as having MI. The AUC of cTnI, H-FABP, myoglobin, and CK-MB were 0.863, 0.827, 0.784, and 0.772, respectively. A logistic regression model using cTnI (P = 0.001) and H-FABP (P < 0.001) had the biggest AUC (0.900) and the best fit determined by BIC. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of this model at 30% probability were 81.6%, 80.9%, 4.26, and 0.23, respectively. H-FABP has a better diagnostic value than both myoglobin and CK-MB as an adjunct to cTnI for the early diagnosis of MI.

Keyword

Myocardial Infarction; Fatty Acid-Binding Proteins; Point-of-Care Systems; Chest Pain

MeSH Terms

Aged
Area Under Curve
Biological Markers/blood
Chest Pain/complications
Creatine Kinase, MB Form/blood
Early Diagnosis
Fatty Acid-Binding Proteins/*blood
Female
Humans
Logistic Models
Male
Middle Aged
Myocardial Infarction/complications/*diagnosis
Myoglobin/blood
Point-of-Care Systems
Predictive Value of Tests
Troponin I/*blood

Figure

• 

  Fig. 1 Receiver operating characteristics curves of initial biochemical markers for the diagnosis of myocardial infarction. cTnI indicates cardiac troponin-I; H-FABP, heart-type fatty acid binding protein; CK-MB, creatine kinase isoenzyme MB. *P value < 0.05 when compared with AUC of cTnI.

• 

  Fig. 2 Receiver operating characteristics curves of logistic regression model for the diagnosis of myocardial infarction. Model 1 was derived using cTnI only as a predictive variable and model 2 was derived using both cTnI and H-FABP. cTnI indicates cardiac troponin-I; H-FABP, heart-type fatty acid binding protein.

Reference

1. Panteghini M. Acute coronary syndrome. Biochemical strategies in the troponin era. Chest. 2002. 122:1428–1435.

2. Thygesen K, Alpert JS, White HD. Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. J Am Coll Cardiol. 2007. 50:2173–2195.

3. Panteghini M, Pagani F, Bonetti G. The sensitivity of cardiac markers: an evidence-based approach. Clin Chem Lab Med. 1999. 37:1097–1106.

4. Apple FS, Quist HE, Doyle PJ, Otto AP, Murakami MM. Plasma 99th percentile reference limits for cardiac troponin and creatine kinase MB mass for use with European Society of Cardiology/American College of Cardiology consensus recommendations. Clin Chem. 2003. 49:1331–1336.

5. Hjortshøj S, Dethlefsen C, Kristensen SR, Ravkilde J. Improved assay of cardiac troponin I is more sensitive than other assays of necrosis markers. Scand J Clin Lab Invest. 2008. 68:130–133.

6. Ilva T, Lund J, Porela P, Mustonen H, Voipio-Pulkki LM, Eriksson S, Pettersson K, Tanner P, Pulkki K. Early markers of myocardial injury: cTnI is enough. Clin Chim Acta. 2009. 400:82–85.

7. Glatz JF, van der Vusse GJ, Simoons ML, Kragten JA, van Dieijen-Visser MP, Hermens WT. Fatty acid-binding protein and the early detection of acute myocardial infarction. Clin Chim Acta. 1998. 272:87–92.

8. Haastrup B, Gill S, Kristensen SR, Jørgensen PJ, Glatz JF, Haghfelt T, Hørder M. Biochemical markers of ischaemia for the early identification of acute myocardial infarction without ST segment elevation. Cardiology. 2000. 94:254–261.

9. Kim YJ, Kim H, Park SM, Cha KC, Lee KH, Hwang SO. The diagnostic value of h-FABP (hearttype fatty acid binding protein) in acute myocardial infarction. J Korean Soc Emerg Med. 2009. 20:163–169.

10. Alhashemi JA. Diagnostic accuracy of a bedside qualitative immunochromatographic test for acute myocardial infarction. Am J Emerg Med. 2006. 24:149–155.

11. Ecollan P, Collet JP, Boon G, Tanguy ML, Fievet ML, Haas R, Bertho N, Siami S, Hubert JC, Coriat P, Montalescot G. Pre-hospital detection of acute myocardial infarction with ultra-rapid human fatty acid-binding protein (H-FABP) immunoassay. Int J Cardiol. 2007. 119:349–354.

12. Górski J, Hermens WT, Borawski J, Mysliwiec M, Glatz JF. Increased fatty acid-binding protein concentration in plasma with chronic renal failure. Clin Chem. 1997. 43:193–195.

13. Chan CP, Sum KW, Cheung KY, Glatz JF, Sanderson JE, Hempel A, Lehmann M, Renneberg I, Renneberg R. Development of a quantitative lateral-flow assay for rapid detection of fatty acid-binding protein. J Immunol Methods. 2003. 279:91–100.

14. Lobo JM, Jiménez-Valverde A, Real R. AUC: a misleading measure of the performance of predictive distribution models. Glob Ecol Biogeogr. 2008. 17:145–151.

15. Schwarz G. Estimating the dimension of a model. Ann Stat. 1978. 6:461–464.

16. Kass RE, Raftery AE. Bayes Factors. J Am Stat Assoc. 1995. 90:773–795.

17. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE 2nd, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B. American College of Cardiology. American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction). American College of Emergency Physicians. Society for Cardiovascular Angiography and Interventions. Society of Thoracic Surgeons. American Association of Cardiovascular and Pulmonary Rehabilitation. Society for Academic Emergency Medicine. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-segment elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 2002 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007. 50:e1–e157.

18. Mad P, Domanovits H, Fazelnia C, Stiassny K, Russmüller G, Cseh A, Sodeck G, Binder T, Christ G, Szekeres T, Laggner A, Herkner H. Human heart-type fatty-acid-binding protein as a point-of-care test in the early diagnosis of acute myocardial infarction. QJM. 2007. 100:203–210.

19. Goto T, Takase H, Toriyama T, Sugiura T, Sato K, Ueda R, Dohi Y. Circulating concentrations of cardiac proteins indicate the severity of congestive heart failure. Heart. 2003. 89:1303–1307.

20. Glatz JF, Kleine AH, van Nieuwenhoven FA, Hermens WT, van Dieijen-Visser MP, van der Vusse GJ. Fatty-acid-binding protein as a plasma marker for the estimation of myocardial infarct size in humans. Br Heart J. 1994. 71:135–140.