title: Heart-type fatty acid-binding protein (H-FABP) as an early diagnostic biomarker in patients with acute chest pain.
abstract: BACKGROUND
  Heart-type fatty acid-binding protein (H-FABP) is an emerging biomarker, which was found to be sensitive for the early diagnosis of acute myocardial infarction (AMI). We prospectively investigated the usefulness of H-FABP determination for the evaluation of acute chest pain in patients arriving at the emergency department.
  
  
  METHODS
  Fifty-four patients presenting with acute ischemic chest pain were evaluated. H-FABP was estimated at admission using latex-enhanced immunoturbidimetric assay. Serial cardiac troponin I (cTnI), creatinine kinase-MB (CK-MB) determination, ischemia workup with stress testing, and/or coronary angiogram (CAG) were performed according to standard protocols.
  
  
  RESULTS
  The sensitivity and specificity of H-FABP was 89.7% and 68%, for cTnI it was 62.1% and 100%, and for CK-MB it was 44.8% and 92%, respectively for diagnosis of AMI. The sensitivity of H-FABP was found to be far superior to initial cTnI and CK-MB, for those seen within 6h (100% vs. 46.1%, 33% respectively). On further evaluation of patients with positive H-FABP and negative cTnI, 71.4% of the patients had significant lesion on CAG, indicating ischemic cause of H-FABP elevation. Six patients with normal cTnI and CK-MB with high H-FABP had ST elevation on subsequent ECGs and were taken for primary angioplasty.
  
  
  CONCLUSIONS
  H-FABP is a highly sensitive biomarker for the early diagnosis of AMI. H-FABP as early marker and cTnI as late marker would be the ideal combination to cover the complete diagnostic window for AMI. Detection of myocardial injury by H-FABP may also be applied in patients with unstable angina. H-FABP can also be used as a marker for early detection of STEMI before the ECG changes become apparent.
authors.affiliation: Department of Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, India.
authors.forename: Anjith
authors.initials: A
authors.lastname: Vupputuri
authors.affiliation: Associate Professor, Department of Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, India.
authors.forename: Saritha
authors.initials: S
authors.lastname: Sekhar
authors.affiliation: Professor, Department of Biochemistry, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, India.
authors.forename: Sajitha
authors.initials: S
authors.lastname: Krishnan
authors.affiliation: Professor and Head, Department of Cardiology, Pushpagiri Institute of Medical Sciences, Tiruvalla, India.
authors.forename: K
authors.initials: K
authors.lastname: Venugopal
authors.affiliation: Professor and Head, Department of Cardiology, Amrita Institute of Medical Sciences and Research, Amrita Vishwa Vidyapeetham University, India. Electronic address: kunatarajan@aims.amrita.edu.
authors.forename: K U
authors.initials: KU
authors.lastname: Natarajan
mesh_terms: D059787:Acute Pain / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D042241:Early Diagnosis; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000096:biosynthesis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D011446:Prospective Studies; D012372:ROC Curve; D013997:Time Factors
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins
keywords: Acute MI; Biochemical marker; Chest pain; Heart-type fatty acid-binding protein