Clinical Evaluation of Point‐of‐Care‐Testing of Heart‐Type Fatty Acid‐Binding Protein (H‐FABP) for the Diagnosis of Acute Myocardial Infarction

Abstract

The present study was carried out for clinical evaluation of point-of-care-testing (POCT) of heart-type fatty acid-binding protein (H-FABP), Rapicheck H-FABP, for the diagnosis of acute myocardial infarction (AMI), in comparison with conventional cardiac biochemical markers such as myoglobin, creatine kinase isoenzyme MB (CK-MB), and cardiac troponin T. Whole blood samples from patients with confirmed AMI (n = 53), patients with non-AMI cardiac diseases (n = 24), and patients with non-cardiac diseases with chest pain (n = 6) were used. When a test line appeared within 15 min after the addition of 150 microL of whole blood, it was designated to be positive for H-FABP. A control line indicates a proper use of the test. On the other hand, when no test line appeared, it was negative. In the superacute phase of AMI within 3 hours, the diagnostic sensitivity of H-FABP was 93.1%, which was the highest of the four markers compared here. The diagnostic specificity in the phase for H-FABP was 64.3%, while it was 100% with cardiac troponin T. The POCT of H-FABP is thought to be practical for the detection of cardiac damage and effective for the diagnosis of AMI in superacute phase within 3 hours and/or 6 hours.

Early diagnosis of postpartum acute myocardial infarction with combined use of troponin T and heart‐type fatty acid‐binding protein rapid assay

“…An H‐FABP assay can detect this protein within 3 h after the onset of AMI 3,16,17 . In our hospital, a whole‐blood rapid panel test on H‐FABP is ready for use at any time 6,7 . Importantly, H‐FABP has a higher sensitivity than troponin T in the early phase of AMI, but has a lower specificity through the early and late phases 6,7,17 …”

“…There are limitations to H‐FABP assays. While H‐FABP exists in high concentrations in the heart, it also exists in much lower concentrations in skeletal muscles 7,16 . After the onset of AMI, H‐FABP leaks from myocardium and the concentration increases in plasma.…”

“…At 07.40 hours, we performed two qualitative panel tests for diagnosis of AMI. The patient presented with a positive result for troponin T above the cut‐off value of 0.10 ng/mL (TROPT sensitive), 2,5 and a positive result for H‐FABP above the cut‐off value of 6.2 ng/mL (Rapicheck H‐FABP) 3,7 . We did not repeat these qualitative tests later.…”

“…2,3 The new definition of AMI emphasizes the significant role of troponin in diagnosis. 4,5 Furthermore, H-FABP is superior to troponin for the detection of AMI within the first 3 h. 6,7 Whole-blood rapid panel tests for troponin T and H-FABP have recently become available and qualitative results can be obtained within 15 min. However, little has been written about postpartum AMI diagnosed with the combined use of these two rapid assays.…”

Evaluation of the diagnostic indices and clinical utility of qualitative cardiodetect® test kit in diagnosis of ami within 12 hours of onset of chest pain in the emergency department

“…The combination test, however, may be redundant as TnT test alone was proven to be adequately sensitive and specific in diagnosing AMI, except for the early hours of chest pain. The Cardio Detect ® test was more sensitive in detecting AMI during the early hours of symptoms and has an added advantage of having a better NPV compared to TnT [35-37]. These characteristics of Cardio Detect ® are crucial since early exclusion of AMI depends on the sensitivity and NPV.…”