Elevated heart-type fatty acid-binding protein levels on admission predict an adverse outcome in normotensive patients with acute pulmonary embolism.
OBJECTIVE
We assessed the predictive value of heart-type fatty acid-binding protein (H-FABP) in normotensive patients with acute pulmonary embolism (PE).


BACKGROUND
Risk stratification of initially normotensive patients with PE on the basis of right ventricular dysfunction or injury remains controversial. Previous studies investigating biomarkers or imaging modalities included unselected patients, some of whom presented with cardiogenic shock.


METHODS
We included 126 consecutive normotensive patients with confirmed PE. Complicated 30-day outcome was defined as death, resuscitation, intubation, or use of catecholamines. Long-term survival was assessed by follow-up clinical examination.


RESULTS
During the first 30 days, 9 (7%) patients suffered complications. These patients had higher baseline H-FABP values (median, 11.2 ng/ml [interquartile range: 8.0 to 36.8 ng/ml]) compared with patients with an uncomplicated course (3.4 ng/ml [2.1 to 4.9 ng/ml]; p < 0.001). H-FABP values were above the calculated (by receiver operating characteristic curve analysis) cutoff value of 6 ng/ml in 29 patients. Eight (28%) of them suffered complications versus 1 of 97 patients with low H-FABP (negative predictive value, 99%; p < 0.001). By logistic regression, elevated (> or =6 ng/ml) H-FABP was associated with a 36.6-fold increase in the death or complication risk. The combination of H-FABP with tachycardia was a particularly useful prognostic indicator. H-FABP also predicted long-term mortality over 499 (interquartile range: 204 to 1,166) days (hazard ratio: 3.6; 95% confidence interval: 1.6 to 8.2; p = 0.003).


CONCLUSIONS
The H-FABP might be a useful biomarker for risk stratification of normotensive patients with acute PE.
Dellas
Claudia
C
Department of Cardiology and Pulmonology, Georg August University of Goettingen, Goettingen, Germany.
Puls
Miriam
M
Lankeit
Mareike
M
Schäfer
Katrin
K
Cuny
Mayumi
M
Berner
Maik
M
Hasenfuss
Gerd
G
Konstantinides
Stavros
S
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D015331:Cohort Studies; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D006801:Humans; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D016019:Survival Analysis
D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins