Early positive biomarker in relation to myocardial necrosis and impaired fatty acid metabolism in patients presenting with acute chest pain at an emergency room.
BACKGROUND
Measurement of circulating biomarkers has enabled early diagnosis and risk assessment of acute coronary syndrome. This study sought diagnostic values of the first single-point data of biomarkers obtained soon after patient arrival by comparing with scintigraphically quantified myocardial injury in patients presenting with acute chest pain at an emergency room.


RESULTS
Serial blood samples were taken soon after arrival in an emergency department in 74 patients with suspected acute coronary syndrome to quantify blood levels of troponin-T (TnT), heart-type fatty acid-binding protein (H-FABP), myocardial-bound creatine kinase (CK-MB), and myoglobin. Myocardial perfusion and metabolic defects were scintigraphically quantified. The first single-point data had high positive predictive values for detecting the defects (80-100%) but low negative predictive values (15-41%). CK-MB and TnT had higher specificities (73-100%) but significantly lower positive rates (22-27%) than the others (61-68%), resulting in greater sensitivities of H-FABP and myoglobin (75-80%) than those of CK-MB and TnT (29-35%). Among biomarkers, TnT peak concentrations most closely correlated with scintigraphic abnormalities.


CONCLUSIONS
H-FABP can contribute to early detection of myocardial injury and TnT is most likely to correlate with injured myocardial mass. The differential features of biomarkers are complementary in patients with acute chest pain presenting at an emergency room.
Second Department of Internal Medicine (Cardiology), Sapporo Medical University School of Medicine, Japan.
Daigo
D
Nagahara
Tomoaki
T
Nakata
Akiyoshi
A
Hashimoto
Toru
T
Takahashi
Michifumi
M
Kyuma
Mamoru
M
Hase
Kazufumi
K
Tsuchihashi
Kazuaki
K
Shimamoto
D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D052279:Creatine Kinase, MB Form / Q000097:blood*; D004636:Emergency Service, Hospital; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005227:Fatty Acids / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D009211:Myoglobin / Q000097:blood; D009336:Necrosis; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D005227:Fatty Acids; D009211:Myoglobin; D020107:Troponin T; D052279:Creatine Kinase, MB Form