title: Plasma heart-type fatty acid binding protein is superior to troponin and myoglobin for rapid risk stratification in acute pulmonary embolism.
abstract: 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.
authors.affiliation: 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>
authors.forename: Anna
authors.initials: A
authors.lastname: Kaczyñska
authors.forename: Maurice M A L
authors.initials: MM
authors.lastname: Pelsers
authors.forename: Anna
authors.initials: A
authors.lastname: Bochowicz
authors.forename: Maciej
authors.initials: M
authors.lastname: Kostrubiec
authors.forename: Jan F C
authors.initials: JF
authors.lastname: Glatz
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
mesh_terms: 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
chemical_list: 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