Heart-type fatty acid-binding protein: an overlooked cardiac biomarker
Harsh Goel1,2, Joshua Melot1, Matthew D Krinock1
1Department of Medicine, St. Luke's University Hospital, Bethlehem, PA, USA.
Insights
Heart-type fatty acid-binding protein (H-FABP) is an early biomarker for myocardial injury, aiding rapid diagnosis in emergency settings. It complements troponins for ruling out acute coronary syndromes and risk-stratifying heart failure and pulmonary embolism patients.
Area of Science:
- Cardiology
- Biomarker Discovery
- Emergency Medicine
Background:
- Cardiac troponins (cTn) are standard for diagnosing acute coronary syndromes (ACS) but require prolonged observation due to slow kinetics.
- Serial cTn measurements for low-risk patients increase emergency department (ED) stay duration and healthcare costs.
- A rapid biomarker for myocardial injury could improve early diagnosis and risk stratification in chest pain patients.
Purpose of the Study:
- To review the evidence on heart-type fatty acid-binding protein (H-FABP) for early diagnosis and risk stratification in patients with chest pain.
- To explore H-FABP's role in non-ACS conditions associated with myocardial injury.
- To highlight H-FABP's potential advantages over cTn in specific clinical scenarios.
Main Methods:
- Literature review of studies investigating H-FABP in chest pain evaluation.
- Analysis of H-FABP's diagnostic and prognostic performance compared to cTn.
- Examination of H-FABP's utility in conditions like acute congestive heart failure (CHF) and acute pulmonary embolism (PE).
Main Results:
- H-FABP is released rapidly (<1 hour) into the plasma after myocardial injury due to its abundance in the myocellular cytoplasm.
- H-FABP shows potential for earlier diagnosis in high-risk patients presenting early after chest pain onset.
- H-FABP aids in rapid risk stratification of low-risk patients and serves as a prognostic marker in CHF and PE.
Conclusions:
- H-FABP is a valuable early biomarker for myocardial injury, complementing troponins in the ED.
- Routine H-FABP use can expedite the exclusion of ACS in early presenters and aid risk stratification.
- H-FABP is also beneficial for prognostic assessment in other conditions causing myocardial injury, such as heart failure and pulmonary embolism.
Abstract:
Cardiac troponins (cTn) are currently the standard of care for the diagnosis of acute coronary syndromes (ACS) in patients presenting to the emergency department (ED) with chest pain (CP). However, their plasma kinetics necessitate a prolonged ED stay or overnight hospital admission, especially in those presenting early after CP onset. Moreover, ruling out ACS in low-risk patients requires prolonged ED observation or overnight hospital admission to allow serial measurements of c-Tn, adding cost. Heart-type fatty acid-binding protein (H-FABP) is a novel marker of myocardial injury with putative advantages over cTn. Being present in abundance in the myocellular cytoplasm, it is released rapidly (<1 h) after the onset of myocardial injury and could potentially play an important role in both earlier diagnosis of high-risk patients presenting early after CP onset, as well as in risk-stratifying low-risk patients rapidly. Like cTn, H-FABP also has a potential role as a prognostic marker in other conditions where the myocardial injury occurs, such as acute congestive heart failure (CHF) and acute pulmonary embolism (PE). This review provides an overview of the evidence examining the role of H-FABP in early diagnosis and risk stratification of patients with CP and in non-ACS conditions associated with myocardial injury. Key messages Heart-type fatty acid-binding protein is a biomarker that is elevated early in myocardial injury The routine use in the emergency department complements the use of troponins in ruling out acute coronary syndromes in patients presenting early with chest pain It also is useful in risk stratifying patients with other conditions such as heart failure and acute pulmonary embolism.
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