Elevated levels of both cardiomyocyte membrane and myofibril damage markers predict adverse outcomes in patients with chronic heart failure.
ABSTRACT Recent studies have shown the presence of ongoing myocardial damage in patients with chronic heart failure (CHF) detected by myofibril and membrane damage markers, cardiac troponin T (TnT) and heart-type fatty acid-binding protein (H-FABP), which identifies patients at increased risk of a future cardiac event (CE: death or rehospitalization because of worsening CHF). There is a difference between TnT and H-FABP in their release kinetics following myocardial damage.
TnT and H-FABP were measured in 103 patients with CHF and in 31 controls. Patients were classified into 4 groups based on detectable (>or=0.01 ng/ml) or undetectable TnT (TnT+ or TnT-) and H-FABP >or= or <4.5 ng/ml (mean + 2 standard deviations in controls) (high-H-FABP or low-H-FABP). Kaplan-Meier analysis showed that the CE-free rate (n=43) was significantly lower in patients with TnT+ and high-H-FABP than in patients in the other 3 groups (patients with TnT+ and low-H-FABP, TnT- and high-H-FABP, and TnT- and low-H-FABP; p=0.02, p=0.001 and p=0.0002, respectively). In stepwise multivariate Cox proportional hazard analysis, TnT+ (p=0.01) and high-H-FABP (p=0.04) were independent predictors of future CE.
Elevated levels of both TnT and H-FABP predict adverse outcomes in CHF patients.
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ABSTRACT: Although, there has been great improvement on the diagnosis and early treatment of acute coronary syndromes, especially in terms of myocardial damage biochemical markers, we do not have a specific marker yet, for using the diagnosis of stable coronary artery disease (CAD). This study aimed to evaluate the relationship between CAD and the changes of heart-type fatty acid binding protein (H-FABP) levels before and after exercise stress testing (EST). A total of 47 patients were enrolled in this observational study. Of 47 patients, 21 had normal coronary anatomy; the remaining 26 patients had coronary lesions over 70% in at least one major coronary artery. All patients performed EST. Along with this, H-FABP levels before EST and at peak exercise, 1st hour, 3rd hour (3h), were measured in all patients. Differences among the measurements were evaluated through the Friedman test and Wilcoxon test, and the Bonferroni correction was applied to determine which measurement caused the difference. Contrary to expectations, the means of the H-FABP values measured at particular intervals for each group tended to decline from the basal level to the 3h level. When the difference between the 3h measurement and the basal level was compared in each group, the decreasing was statistically significant in both groups (p<0.05). A statistically significant decrease at the 3h measurement compared to the basal level in the CAD group was more apparent than in the control group (2.790±2.569 ng/ml vs. 0.837±2.070 ng/ml, p=0.009). We found that H-FABP levels did not increase during EST and contrary to expectation, were inclined to decrease. We thought that decreasing H-FABP levels likely resulted from exercise-induced proteinuria.Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 12/2011; 11(8):685-91. · 0.72 Impact Factor
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ABSTRACT: Heart failure (HF) is a major public health problem and the approach for an accurate individualization of HF risk and care should include a profile of laboratory data, in addition to clinical and imaging data. The possibility of identifying the most vulnerable patients is clinically important, especially considering that many therapeutic interventions are available today. This goal has not been yet reached although many novel biomarkers have been proposed and tested. The complexity of the biochemical network at the basis of HF pathophysiology clearly suggests that a single marker cannot reflect all the features of this syndrome, whereas the combined use of more indices would better characterize HF patients and create new options for their management, helping identify which patients to follow more closely. The multimarker approach, considering various biochemical pathways simultaneously, bases its robustness on a suitable choice of indices known to be individually associated with HF. The choice of biomarker combination is essential to the performance of the multimarker strategy. A major problem in selecting the biomarker profile is the proportional increase in economic burden; thus a "parsimonious" biomarker combination has to be used in a cost-effective evaluation. Statistical analysis and analytical performance of the different elements of the combination, in turn, may heavily influence results. This review summarizes the results obtained using a multimarker approach for HF risk stratification, for predicting HF incidence in a population, and evaluating the response to therapy. An insight into transcriptomic biomarkers, recently proposed for HF individual risk assessment, is also reported. A reliable selection of biomarkers for the careful management of HF patients is of pivotal importance in reducing healthcare costs without reducing patient care.Pharmacological Research 03/2011; 64(1):11-24. · 4.35 Impact Factor
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ABSTRACT: Biomarkers predicting adverse outcomes in non-surgical intensive care patients have not been reported. Data for 1,006 emergency department patients were prospectively analyzed. The serum heart-type fatty acid-binding protein (s-H-FABP) level was measured within 10 min of admission. The patients were assigned to intensive care (n = 835) or other departments (n = 171). The intensive care patients were divided into survivors (n = 745) and non-survivors (n = 90) according to the in-hospital mortality and assigned to four groups according to the quartiles of s-H-FABP (Q1, Q2, Q3 and Q4). The s-H-FABP levels were significantly higher in the intensive care patients (12.7 [6.1-38.8] ng/ml versus 5.3 [3.1-9.4] ng/ml) and in the non-survivors (44.9 [23.2-87.6] ng/ml versus 11.5 [5.6-32.6] ng/ml). A Kaplan-Meier curve showed a significantly higher survival rate in Q3 than in Q1 and Q2 and in Q4 than in the other groups. The multivariate Cox regression model identified Q3 (HR 4.646, 95 % CI 1.526-14.146) and Q4 (HR 9.483, 95 % CI 3.152-28.525) as independent predictors of 90-day mortality. The sensitivity and specificity of H-FABP for in-hospital mortality were 81.1 and 66.0 % (AUC 0.775) at 20.95 ng/ml. The in-hospitality rate was significantly higher in the high s-H-FABP patients than in the low s-H-FABP patients in each etiology group. The s-H-FABP level is an effective biomarker for risk stratification in non-surgical intensive care patients.Clinical Research in Cardiology 05/2014; · 3.67 Impact Factor