title: Heart-Type Fatty Acid Binding Protein and Ischemia-Modified Albumin for Detection of Myocardial Infarction After Coronary Artery Bypass Graft Surgery.
abstract: BACKGROUND
  Heart-type fatty acid binding protein (hFABP) and ischemia-modified albumin (IMA) have been put forward as novel biomarkers to detect myocardial injury shortly after onset of ischemia. We compared hFABP and IMA with cardiac troponin I (cTnI) for speed and reliability in the diagnosis of perioperative myocardial infarction (PMI) after coronary artery bypass graft surgery (CABG).
  
  
  METHODS
  In all, 210 consecutive patients undergoing isolated CABG with cardiopulmonary bypass were enrolled in a prospective study. Blood samples were taken perioperatively and throughout the first 72 hours after surgery; clinical data and events were recorded. In cohort A, serum concentrations of hFABP and cTnI were measured using a combined quantitative bedside assay. In cohort B, IMA and cTnI serum concentrations were measured using an albumin cobalt binding test. Perioperative myocardial infarction was defined using a cTnI cutoff of greater than 10.5 ng/mL occurring within 24 hours of CABG or new electrocardiographic changes.
  
  
  RESULTS
  In cohort A, 14 patients were identified with PMI (group 1), whereas 94 had no PMI and served as controls (group 2). Both hFABP and cTnI were increased in group 1 as compared with group 2 (p < 0.001). Although cTnI did not differ before 12 hours, hFABP diverged much earlier, at 1 hour postoperatively (p < 0.001). An hFABP concentration of 20 μg/mL at 1 hour detected PMI with an area under the curve of 77.1%. In cohort B, 18 patients were identified with PMI (group 3), and 84 patients served as controls (group 4). No difference in cTnI values could be observed between the groups until 12 hours postoperatively. Ischemia-modified albumin failed to differentiate at any postoperative time point; the low discriminative power of IMA was confirmed with an area under the curve of 53.3% at 1 hour, 48.5% at 6 hours, and 39.3% at 12 hours postoperatively.
  
  
  CONCLUSIONS
  Heart-type fatty acid binding protein is a sensitive and rapid biomarker that detected PMI reliably at 1 hour after CABG, much earlier than cTnI. The diagnostic value of IMA for detection of PMI appears to be very limited in this setting.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany. Electronic address: matthias.thielmann@uni-due.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Pasa
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Torulv
authors.initials: T
authors.lastname: Holst
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendt
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Daniel-Sebastian
authors.initials: DS
authors.lastname: Dohle
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Ender
authors.initials: E
authors.lastname: Demircioglu
authors.affiliation: Hatter Cardiovascular Institute, London, United Kingdom, and Department of Internal Medicine, The Cleveland Clinic, Cleveland, Ohio.
authors.forename: Vikram
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011183:Postoperative Complications; D011446:Prospective Studies; D012709:Serum Albumin; D000075462:Serum Albumin, Human
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; C561522:ischemia-modified albumin; D000075462:Serum Albumin, Human