Heart-type Fatty Acid-binding Protein Enables Rapid Risk Stratification In Patients With Pulmonary Embolism

Abstract

Introduction: Elevated serum troponin levels are a reliable indicator of right ventricular wall stress in patients with acute pulmonary artery embolism (PE). Raised troponin levels have been shown to predict adverse clinical outcome in these individuals. In this context it was our aim to determine the additional role of the heart-type fatty acid-binding protein (H-FABP) in patients with acute PE. Methods: 87 consecutive patients with confirmed PE were included in the present study. On arrival a qualitative H-FABP-test (positive cutoff 7ng/ml) and a detailed echocardiographic study were performed in all patients. These findings were related to both in hospital and 30 days mortality. Results: Of the included 87 patients, 17 had positive H-FABP-tests. Right ventricular function was severely deteriorated in 10 patients (59%) in the H-FABP-positive group but only in 2 patients (3%) of the H-FABPnegative group (p<0.005). 15/17 patients (88%) of the H-FABP-positive group needed inotropic support, of these, 14 (82%) died in hospital. Only one patient with a H-FABP-negative test (n= 70) needed vasoactive drugs, and none of these patients died (p<0.005). Conclusion: H-FABP showed a better correlation with in-hospital mortality and RV-function than troponin I. Our data show that H-FABP significantly correlates with in hospital and 30-day mortality in patients with PE. Furthermore, it is associated with impaired right ventricular function and showed better correlation with mortality in patients with PE as compared to Troponin I. Thus, it may be viewed as a novel and promising tool to optimise the management strategy in these patients.

Risk stratification in acute pulmonary embolism with heart-type fatty acid–binding protein: A meta-analysis

“…Eleven full-text studies were excluded because 3 of them appeared to report on the same patients included in other analyzed studies and 8 studies did not report required end points. Two abstracts and 9 full-text studies were included in the final analysis [9,10,[15][16][17][18][19][20][21][22][23]. Of a total of 11 studies, 2 studies have overlapping of patients, but they have different end points so they were included in the analysis of different end points [10,19].…”

“…Four studies reported on RVD in pulmonary embolism [10,16,19,22]. The risk of RVD was significantly higher in patients with elevated H-FABP as compared with patients with normal H-FABP (OR, 2.57; 95% CI, 1.05-6.33; I 2 = 57%), as shown in Fig.…”

“…Similarly, of the studies by Wunderlich et al and Boscheri et al, former study had more patients' volume and reported 30-day mortality as its outcomes but did not report 30-day complicated clinical course as well as PE-related mortality, so Boscheri et al was included in 30-day complicated clinical events as well as 30-day PE mortality analysis. All studies excluded patients with hemodynamically unstable PE, except 2 studies, Richter et al [19] and Kaczyñska et al [9]. All studies reported 30-day outcomes, except the study by Vuilleumier et al [18], which reported 90-day outcome.…”

“…To increase the number of patients, we included the study of Veullieumier et al in our 30-day analysis. Only 6 studies reported separate mortality data, and these were included in 30-day mortality analysis [9,15,17,19,20,22]. Characteristics of H-FABP assays are shown in Table 2.…”

“…Six prospective studies reported on 30-day mortality resulting from pulmonary embolism [9,15,17,19,22,23]. Overall, 73 deaths were Fig.…”