Biochemical Markers of Ischaemia for the Early Identification of Acute Myocardial Infarction without ST Segment Elevation

Abstract

Blood was collected on admission and after 1–2 h in 130 consecutive patients admitted with typical chest pain in order to assess the capacity of myoglobin, fatty-acid-binding protein (FABP), CK-MB mass, and troponin I (TnI) in the early identification of acute myocardial infarction (AMI) without ST elevation. Using the maximum value within 6 h of onset of symptoms, AMI was detected with a 90–95% sensitivity and a 81–94% specificity by FABP at a cut-off level 8–12 µg/l, or 81–86% and 89–93%, respectively, by myoglobin at a cut-off level 70–90 µg/l. CK-MB mass and TnI had low sensitivity, albeit very high specificity. As almost all AMI patients were identified within 6 h, serial measurements of FABP or myoglobin ruled out AMI with a very high degree of certainty. Due to the low prevalence of AMI (16%), the positive predictive values were modest (47–73%), yet increasing the probability of AMI by a factor 3–4. Myoglobin and FABP are very useful markers in the early triage of chest pain patients.

Heart Fatty Acid Binding Protein (H-FABP) as a Diagnostic Biomarker in Patients with Acute Coronary Syndrome

“…Recent studies suggest that human heart type fatty acid binding protein (H-FABP) may be a potential marker for early diagnosis of ACS. Fatty acid-binding proteins (FABPs) are relatively small cytoplasmic proteins (12)(13)(14)(15) KDa) that are abundant in tissues with active fatty acid metabolism, including the heart. In fact, heart-type FABP (H-FABP) is particularly important for myocardial homoeostasis, since 50-80% of the heart's energy is provided by lipid oxidation and H-FABP ensures intracellular transport of insoluble fatty acids.…”

New insights into the structure and function of fatty acid-binding proteins

“…Human H-FABP can be determined in extracellular fluids such as plasma and urine [267 -270]. FABP released after acute myocardial infarction is quantitatively recovered in plasma, making it a useful biochemical plasma marker for the estimation of infarct size in humans [269,271,272]. The diagnostic sensitivity was significantly higher for H-FABP than for myoglobin [273].…”

Difference in Elevation of N-Terminal Pro-BNP and Conventional Cardiac Markers Between Patients With ST Elevation vs Non-ST Elevation Acute Coronary Syndrome

“…19 Novel cardiac markers, such as troponin T (TnT), and creatine kinase (CK)-MB isozyme, detect the development of minor myocardial necrosis, and have emerged as powerful predictors of risk in patients with ACS. [20][21][22][23] The present study investigated differences in the secretion of NT-proBNP and conventional cardiac markers in patients with STE-ACS vs NSTE-ACS.…”