Heart-type fatty acid binding protein as an early marker for myocardial infarction: systematic review and meta-analysis

Carroll, Christopher; Khalaf, M Al; Stevens, John; Leaviss, J; Goodacre, Steve; Collinson, Paul; Wang, Jenny

doi:10.1136/emermed-2012-201174

Cited by 44 publications

(23 citation statements)

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“…The results of meta analysis has been mixed with early reports that hFABP does not meet the criteria for an early diagnostic test14 15 but more recent studies supporting a degree of added value for additional measurement of HFABP plus cTn but at the expense of a significant reduction in diagnostic specificity 16. HFABP has been shown to be a prognostic marker in patients with chest pain and suspected ACSs17–19 suggesting its role may be an ischaemia marker rather than a necrosis marker alone.…”

Section: Discussionmentioning

confidence: 99%

Comparison of contemporary troponin assays with the novel biomarkers, heart fatty acid binding protein and copeptin, for the early confirmation or exclusion of myocardial infarction in patients presenting to the emergency department with chest pain

Collinson

Gaze

Goodacre

2013

Heart

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Section: Discussionmentioning

confidence: 99%

Comparison of contemporary troponin assays with the novel biomarkers, heart fatty acid binding protein and copeptin, for the early confirmation or exclusion of myocardial infarction in patients presenting to the emergency department with chest pain

Collinson

Gaze

Goodacre

2013

Heart

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“…hFABP can be of added clinical value, especially in a multimarker approach (3,4,24,26,31), but contradictory evidence exists (1,19,30). This may stem from difficulties in estimating the time from onset of ischemia to presentation, as well as variations in onset of spontaneous reperfusion and presence of collateral flow.…”

Section: H1106 Hfabp For Acute Myocardial Infarct Size and No-reflowmentioning

confidence: 96%

Serial measurement of hFABP and high-sensitivity troponin I post-PCI in STEMI: how fast and accurate can myocardial infarct size and no-reflow be predicted?

Uitterdijk

Sneep

Duin

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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The objective of this study was to compare heart-specific fatty acid binding protein (hFABP) and high-sensitivity troponin I (hsTnI) via serial measurements to identify early time points to accurately quantify infarct size and no-reflow in a preclinical swine model of ST-elevated myocardial infarction (STEMI). Myocardial necrosis, usually confirmed by hsTnI or TnT, takes several hours of ischemia before plasma levels rise in the absence of reperfusion. We evaluated the fast marker hFABP compared with hsTnI to estimate infarct size and no-reflow upon reperfused (2 h occlusion) and nonreperfused (8 h occlusion) STEMI in swine. In STEMI (n = 4) and STEMI + reperfusion (n = 8) induced in swine, serial blood samples were taken for hFABP and hsTnI and compared with triphenyl tetrazolium chloride and thioflavin-S staining for infarct size and no-reflow at the time of euthanasia. hFABP increased faster than hsTnI upon occlusion (82 ± 29 vs. 180 ± 73 min, P < 0.05) and increased immediately upon reperfusion while hsTnI release was delayed 16 ± 3 min (P < 0.05). Peak hFABP and hsTnI reperfusion values were reached at 30 ± 5 and 139 ± 21 min, respectively (P < 0.05). Infarct size (containing 84 ± 0.6% no-reflow) correlated well with area under the curve for hFABP (r(2) = 0.92) but less for hsTnI (r(2) = 0.53). At 50 and 60 min reperfusion, hFABP correlated best with infarct size (r(2) = 0.94 and 0.93) and no-reflow (r(2) = 0.96 and 0.94) and showed high sensitivity for myocardial necrosis (2.3 ± 0.6 and 0.4 ± 0.6 g). hFABP rises faster and correlates better with infarct size and no-reflow than hsTnI in STEMI + reperfusion when measured early after reperfusion. The highest sensitivity detecting myocardial necrosis, 0.4 ± 0.6 g at 60 min postreperfusion, provides an accurate and early measurement of infarct size and no-reflow.

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“…In particular, as a standalone test, HT FABP seems to perform poorly compared to contemporary troponin assays. 5,6 Carroll et al 6 performed a systemic review and meta-analysis of 17 studies evaluating the role of HT FABP at presentation in the early diagnosis of AMI. They reported a pooled sensitivity and specificity of 81% (95% confidence intervals [CI]: 50-95%) and 80% (26-98%), respectively, for the quantitative assays, and 68% (11-97%) and 92% (20-100%), respectively, for the qualitative assays.…”

Section: Introductionmentioning

confidence: 99%

Heart-type fatty acid binding protein in early diagnosis of myocardial infarction in the era of high-sensitivity troponin: a systematic review and meta-analysis

Liou

2014

Ann Clin Biochem

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Introduction: Heart-type fatty acid binding protein (HT FABP) is an emerging biomarker of ischaemic myocardial necrosis. While previous studies have demonstrated its additive value when compared to contemporary troponin assays in the diagnosis of acute myocardial infarction (AMI), its utility in the era of high-sensitivity troponin (hsTn) assays remains undetermined. Methodology: A systematic review and meta-analysis of relevant studies was performed comparing the diagnostic performance of HT FABP both alone and in conjunction with hsTn in the early diagnosis and exclusion of AMI. Results: A systematic literature search yielded eight eligible studies including 3395 patients. Of these, 716 patients (21.1%) were eventually diagnosed with AMI. The pooled sensitivity and specificity for hsTn on admission was 82.5% (95% confidence interval [CI]: 79.8-85.0%) and 89.7% (95% CI: 88.7-90.6%), respectively, while the area under the curve (AUC) for the summary receiver operating characteristics (ROC) curve is 0.92 (SE 0.02). While the pooled specificity (84.6%, 95% CI: 83.2-85.9%) of admission HT FABP is similar to hsTn for the early diagnosis of AMI (P ¼ 0.07), its pooled sensitivity (63.5%, 95% CI: 59.9-67.1%, P < 0.001) is significantly worse. Accordingly, the AUC of the summary ROC curve for HT FABP (0.79, SE 0.03) is inferior to hsTn (P < 0.0001). The addition of HT FABP to hsTn resulted in no improvement in the sensitivity (P ¼ 0.058) and worsened the specificity (P ¼ 0.001) in the early diagnosis of AMI compared to hsTn alone. Conclusion: HT FABP does not appear to improve the diagnostic accuracy of hsTn, and consequently its routine use currently cannot not be recommended.

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Heart-type fatty acid binding protein as an early marker for myocardial infarction: systematic review and meta-analysis

Cited by 44 publications

References 45 publications

Comparison of contemporary troponin assays with the novel biomarkers, heart fatty acid binding protein and copeptin, for the early confirmation or exclusion of myocardial infarction in patients presenting to the emergency department with chest pain

Comparison of contemporary troponin assays with the novel biomarkers, heart fatty acid binding protein and copeptin, for the early confirmation or exclusion of myocardial infarction in patients presenting to the emergency department with chest pain

Serial measurement of hFABP and high-sensitivity troponin I post-PCI in STEMI: how fast and accurate can myocardial infarct size and no-reflow be predicted?

Heart-type fatty acid binding protein in early diagnosis of myocardial infarction in the era of high-sensitivity troponin: a systematic review and meta-analysis

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