Plasma heart-type fatty acid binding protein is superior to troponin and myoglobin for rapid risk stratification in acute pulmonary embolism.
BACKGROUND
Irreversible right ventricular (RV) failure with myocardial damage may precipitate fatal outcome in acute pulmonary embolism (APE). Cytoplasmic heart-type fatty acid binding protein (H-FABP) is a sensitive and specific biomarker of myocardial damage. We assessed which biomarker of myocardial damage or RV stretching is the most useful for short-term risk stratification in APE.


METHODS
We analyzed 77 patients (51 F, 26 M) aged 65.3+/-16.0 years with confirmed APE. On admission, systemic blood pressure and transthoracic echocardiography (for RV overload) were recorded and plasma concentrations of myoglobin (Mb), cardiac troponin T (cTnT), N-terminal fragment of proBNP (NT-proBNP) and H-FABP were evaluated.


RESULTS
Fifteen (19.5%) patients died and 24 (31.2%) experienced complicated clinical course (CCC)-death/thrombolysis/cardiopulmonary resuscitation/intravenous vasopressors. Hazard ratio analysis demonstrated that plasma H-FABP, Mb, cTnT and NT-proBNP concentrations predicted fatal outcome. When only APE-related deaths were considered, plasma H-FABP concentrations indicated fatal outcome. Multivariate hazard ratio analysis revealed H-FABP as the only 30-day mortality predictor (HR 1.02 CI 95% 1.01-1.05).


CONCLUSIONS
H-FABP measured on admission is useful for short-term risk stratification in APE. It appears to be superior to cTnT, NT-proBNP and Mb in the prediction of 30-day APE-related mortality.
Kaczyñska
Anna
A
Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland. kaczan76@poczta.onet.pl <kaczan76@poczta.onet.pl>
Pelsers
Maurice M A L
MM
Bochowicz
Anna
A
Kostrubiec
Maciej
M
Glatz
Jan F C
JF
Pruszczyk
Piotr
P
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D016887:Cardiopulmonary Resuscitation; D004452:Echocardiography; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D006801:Humans; D008875:Middle Aged; D009211:Myoglobin / Q000097:blood*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D018570:Risk Assessment / Q000379:methods; D015912:Thrombolytic Therapy; D014336:Troponin / Q000097:blood*; D014662:Vasoconstrictor Agents / Q000494:pharmacology
D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D009211:Myoglobin; D010446:Peptide Fragments; D014336:Troponin; D014662:Vasoconstrictor Agents; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain