title: Serial measurement of hFABP and high-sensitivity troponin I post-PCI in STEMI: how fast and accurate can myocardial infarct size and no-reflow be predicted?
abstract: The objective of this study was to compare heart-specific fatty acid binding protein (hFABP) and high-sensitivity troponin I (hsTnI) via serial measurements to identify early time points to accurately quantify infarct size and no-reflow in a preclinical swine model of ST-elevated myocardial infarction (STEMI). Myocardial necrosis, usually confirmed by hsTnI or TnT, takes several hours of ischemia before plasma levels rise in the absence of reperfusion. We evaluated the fast marker hFABP compared with hsTnI to estimate infarct size and no-reflow upon reperfused (2 h occlusion) and nonreperfused (8 h occlusion) STEMI in swine. In STEMI (n = 4) and STEMI + reperfusion (n = 8) induced in swine, serial blood samples were taken for hFABP and hsTnI and compared with triphenyl tetrazolium chloride and thioflavin-S staining for infarct size and no-reflow at the time of euthanasia. hFABP increased faster than hsTnI upon occlusion (82 ± 29 vs. 180 ± 73 min, P < 0.05) and increased immediately upon reperfusion while hsTnI release was delayed 16 ± 3 min (P < 0.05). Peak hFABP and hsTnI reperfusion values were reached at 30 ± 5 and 139 ± 21 min, respectively (P < 0.05). Infarct size (containing 84 ± 0.6% no-reflow) correlated well with area under the curve for hFABP (r(2) = 0.92) but less for hsTnI (r(2) = 0.53). At 50 and 60 min reperfusion, hFABP correlated best with infarct size (r(2) = 0.94 and 0.93) and no-reflow (r(2) = 0.96 and 0.94) and showed high sensitivity for myocardial necrosis (2.3 ± 0.6 and 0.4 ± 0.6 g). hFABP rises faster and correlates better with infarct size and no-reflow than hsTnI in STEMI + reperfusion when measured early after reperfusion. The highest sensitivity detecting myocardial necrosis, 0.4 ± 0.6 g at 60 min postreperfusion, provides an accurate and early measurement of infarct size and no-reflow.
authors.affiliation: Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: André
authors.initials: A
authors.lastname: Uitterdijk
authors.forename: Stefan
authors.initials: S
authors.lastname: Sneep
authors.forename: Richard W B
authors.initials: RW
authors.lastname: van Duin
authors.forename: Ilona
authors.initials: I
authors.lastname: Krabbendam-Peters
authors.forename: Charlotte
authors.initials: C
authors.lastname: Gorsse-Bakker
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Duncker
authors.forename: Willem J
authors.initials: WJ
authors.lastname: van der Giessen
authors.forename: Heleen M M
authors.initials: HM
authors.lastname: van Beusekom
mesh_terms: D000818:Animals; D052160:Benzothiazoles; D015415:Biomarkers / Q000097:blood; D003326:Coronary Circulation; D004195:Disease Models, Animal; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006439:Hemodynamics; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000009:adverse effects*; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D009336:Necrosis; D054318:No-Reflow Phenomenon / Q000097:blood / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D012307:Risk Factors; D013194:Staining and Labeling / Q000379:methods; D013552:Swine; D013778:Tetrazolium Salts; D013844:Thiazoles; D013997:Time Factors; D019210:Troponin I / Q000097:blood*; D015854:Up-Regulation
chemical_list: D052160:Benzothiazoles; D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D013778:Tetrazolium Salts; D013844:Thiazoles; D019210:Troponin I; C009462:thioflavin T; C009591:triphenyltetrazolium
keywords: STEMI model; acute myocardial infarction; heart-specific fatty acid binding protein; high-sensitivity troponin I; markers of myocardial necrosis; no reflow