title: Ischemic biomarker heart-type fatty acid binding protein (hFABP) in acute heart failure - diagnostic and prognostic insights compared to NT-proBNP and troponin I.
abstract: BACKGROUND
  To evaluate diagnostic and long-term prognostic values of hFABP compared to NT-proBNP and troponin I (TnI) in patients presenting to the emergency department (ED) suspected of acute heart failure (AHF).
  
  
  METHODS
  401 patients with acute dyspnea or peripheral edema, 122 suffering from AHF, were prospectively enrolled and followed up to 5 years. hFABP combined with NT-proBNP versus NT-proBNP alone was tested for AHF diagnosis. Prognostic value of hFABP versus TnI was evaluated in models predicting all-cause mortality (ACM) and AHF related rehospitalization (AHF-RH) at 1 and 5 years, including 11 conventional risk factors plus NT-proBNP.
  
  
  RESULTS
  Additional hFABP measurements improved diagnostic specificity and positive predictive value (PPV) of sole NT-proBNP testing at the cutoff <300 ng/l to "rule out" AHF. Highest hFABP levels (4th quartile) were associated with increased ACM (hazard ratios (HR): 2.1-2.5; p = 0.04) and AHF-RH risk at 5 years (HR 2.8-8.3, p = 0.001). ACM was better characterized in prognostic models including TnI, whereas AHF-RH was better characterized in prognostic models including hFABP. Cox analyses revealed a 2 % increase of ACM risk and 3-7 % increase of AHF-RH risk at 5 years by each unit increase of hFABP of 10 ng/ml.
  
  
  CONCLUSIONS
  Combining hFABP plus NT-proBNP (<300 ng/l) only improves diagnostic specificity and PPV to rule out AHF. hFABP may improve prognosis for long-term AHF-RH, whereas TnI may improve prognosis for ACM.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00143793 .
authors.affiliation: First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. ursula.hoffmann@umm.de.
authors.forename: Ursula
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. florian.espeter@med.uni-duesseldorf.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Espeter
authors.affiliation: Department of Statistical Analysis, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany. christel.weiss@medma.uni-heidelberg.de.
authors.forename: Christel
authors.initials: C
authors.lastname: Weiß
authors.affiliation: Institute for Microbiology and Laboratory Medicine, HELIOS Klinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany. parviz.ahmad-nejad@helios-kliniken.de.
authors.forename: Parviz
authors.initials: P
authors.lastname: Ahmad-Nejad
authors.affiliation: First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. siegfried.lang@umm.de.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Lang
authors.affiliation: Boehringer Ingelheim GmbH & Co. KG, Ingelheim am Rhein, Germany. martina.brueckmann@boehringer-ingelheim.com.|Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany. martina.brueckmann@boehringer-ingelheim.com.
authors.forename: Martina
authors.initials: M
authors.lastname: Brueckmann
authors.affiliation: First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. ibrahim.akin@umm.de.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
authors.affiliation: Institute for Clinical Chemistry, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany. michael.neumaier@umm.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Neumaier
authors.affiliation: First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. martin.borggrefe@umm.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.affiliation: First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. michael.behnes@umm.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Behnes
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D004452:Echocardiography; D004487:Edema / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D004636:Emergency Service, Hospital; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000175:diagnosis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010359:Patient Readmission; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D019210:Troponin I / Q000097:blood*; D055815:Young Adult
chemical_list: C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain