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Prognostic impact of elevated fatty acid-binding protein 1 in patients with heart failure
Kazuki Kagami1,2, Hiroaki Sunaga1,3, Hidemi Sorimachi1
1Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
Insights
Elevated serum Fatty Acid-Binding Protein 1 (FABP1) levels in heart failure (HF) patients indicate worse outcomes. FABP1 may be a novel biomarker for assessing cardio-hepatic interactions in HF.
Area of Science:
- Cardiology
- Biomarker Discovery
- Hepatic Physiology
Background:
- Limited biomarkers exist for extra-cardiac changes in heart failure (HF).
- Fatty Acid-Binding Protein 1 (FABP1), primarily in the liver, is a potential biomarker for liver injury.
- The role of FABP1 in HF pathophysiology is largely unknown.
Purpose of the Study:
- To investigate FABP1 as a potential biomarker in patients with compensated heart failure.
- To assess the association between FABP1 levels and clinical outcomes in HF patients.
Main Methods:
- Serum FABP1 levels and echocardiography were measured in 162 compensated HF patients and 20 controls.
- Patients were followed for mortality or HF hospitalization.
- Statistical analyses correlated FABP1 with hemodynamic measures and outcomes.
Main Results:
- FABP1 levels were significantly higher in HF patients compared to controls (17.6 vs. 7.9 ng/mL).
- FABP1 correlated with right ventricular systolic and right atrial pressures.
- The highest FABP1 tertile showed a 3-fold increased risk of adverse outcomes, independently of other factors.
Conclusions:
- Elevated serum FABP1 is associated with worse outcomes in compensated HF.
- FABP1 may serve as a novel biomarker for cardio-hepatic interactions in HF.
- FABP1 independently predicts adverse events and improves prognostic models.
Aims:
Few biomarkers to evaluate pathophysiological changes in extra-cardiac tissues have been identified in patients with heart failure (HF). Fatty acid-binding protein 1 (FABP), also known as liver FABP, is predominantly expressed in the liver. Circulating FABP1 has been proposed to be a sensitive biomarker for liver injury. However, little is known about the potential role of FABP1 as a biomarker for HF.
Methods And Results:
Measurements of serum FABP1 and echocardiography were performed in subjects with compensated HF (n = 162) and control subjects without HF (n = 20). Patients were prospectively followed-up for a composite outcome of all-cause mortality or HF hospitalization. Compared with control subjects, levels of FABP1 were elevated in HF patients [7.9 (6.4-11.7) vs. 17.6 (10.4-28.9) ng/mL, P < 0.0001]. There were significant correlations between FABP1 levels and estimated right ventricular systolic pressure and right atrial pressure. During a median follow-up of 12.0 months, there were 55 primary composite endpoints in the HF cohort. The highest FABP1 tertile was associated with a three-fold increased risk of the composite outcome compared with the lowest tertile [95% confidence interval (1.46-6.68), P = 0.003], but other conventional hepatobiliary markers did not predict the outcome. After adjusting for age, sex, atrial fibrillation, and N-terminal pro-B-type natriuretic peptide levels, serum FABP1 remained independently associated with the outcome. Adding FABP1 to the model based on clinical factors and N-terminal pro-B-type natriuretic peptide significantly improved the prognostic value (global χ2 20.8 vs. 15.5, P = 0.01).
Conclusion:
Serum FABP1 levels are elevated in compensated HF patients, and the magnitude of elevation is independently associated with pulmonary hypertension, right atrial hypertension, and worse clinical outcomes. FABP1 may serve as a new potential biomarker for the assessment of hitherto unrecognized derangement of cardio-hepatic interaction in HF.
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