Diagnostic value of a heart-type fatty acid-binding protein (H-FABP) bedside test in suspected acute coronary syndrome in primary care

Slot, M.H.E. Bruins; Rutten, Frans H.; Heijden, Geert J. M. G. van der; Doevendans, Pieter A.; Mast, E. Gijs; Bredero, Ad C.; Spoel, O.P. van der; Glatz, Jan F. C.; Hoes, Arno W.

doi:10.1016/j.ijcard.2012.12.050

Cited by 27 publications

(20 citation statements)

References 19 publications

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“…The incidence of ACS was 10.6%, comparable with previous findings in the literature, where incidences of 1.5% to 22% were described. [28][29][30][31][32][33] The study team focused on deriving factors to be included in an algorithm of signs and symptoms combined with POC H-FABP testing predictive of ACS (stage 2 of the aforementioned stages of Stiell and Wells). 19 All criteria for a methodologically correct stage 2 (definition of outcomes and predictor variables, generalisability of subject selection, several statistical and methodological demands) are present in this study, except the inter-observer reliability for the clinical findings, which is difficult to measure in an acute setting.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…In an earlier study, based on a POC H-FABP test with a cut-off value of 7 ng/ml, performance of the test in clinical situations was insufficient. 28 The present study worked with a promising new POC H-FABP test with a cut-off value of 4 ng/ml, based on a clinical study with patients with chest pain in a secondary care emergency setting. 18 However, performance of this POC H-FABP test as a stand-alone test was insufficient.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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Evaluating possible acute coronary syndrome in primary care: the value of signs, symptoms, and plasma heart-type fatty acid-binding protein (H-FABP). A diagnostic study

et al. 2019

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BackgroundAdditional diagnostic means could be of added value when evaluating possible acute coronary syndrome (ACS) in primary care.AimTo determine whether heart-type fatty acid-binding protein (H-FABP)-based point-of-care (POC) biomarker testing, embedded in a clinical decision rule (CDR), is helpful to the GP when evaluating possible ACS.Design & settingA prospective, non-randomised, double-blinded, diagnostic derivation study was undertaken, with a delayed-type cross-sectional diagnostic model among GPs in the Netherlands and Belgium.MethodSigns and symptoms predicting acute myocardial infarction (AMI) or ACS were identified using both logistic regression analysis, and classification and regression trees (CART). Diagnostic values of the POC H-FABP test (cut-off value 4 ng/ml) alone and as part of a CDR were determined.ResultsA total of 303 participants (48.8% male) with chest pain or discomfort who had consulted a GP were enrolled. ACS was found in 32 (10.6%) of these 303 patients. For ACS, sensitivity and negative predictive value (NPV) of the POC H-FABP test was 25.8% (95% confidence interval [CI] = 12.5 to 44.9) and 91.6% (95% CI = 87.6% to 94.5%), respectively. The area under the receiver operating curve of the optimal CDR was 0.78 for ACS.ConclusionSensitivity of the current H-FABP POC test (cut-off value 4 ng/ml) as a stand-alone test is poor, either owing to limitations of the marker or of the test device. Usability of a CDR derived from these results is doubtful: the number of ACS cases missed by the GP is reduced but, as a consequence, disproportionally more ACS-negative patients are referred.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Comparison With Existing Literaturementioning

confidence: 99%

Evaluating possible acute coronary syndrome in primary care: the value of signs, symptoms, and plasma heart-type fatty acid-binding protein (H-FABP). A diagnostic study

et al. 2019

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“…Regarding laboratory testing, different types of assays are frequently used in research and clinical settings for the detection and quantification of H-FABP in serum, plasma, or whole blood. These assays comprise enzyme-linked immunosorbent assays (ELISA) [6,15,[35][36][37], immunoturbidimetric assays [38,39], multiplex assays [40,41], and immunochromatographic assays [42,43]. Test times depend on the type of assay, and vary between 5 and 120 minutes (as reviewed in [44]).…”

Section: Introductionmentioning

confidence: 99%

Heart-Type Fatty Acid-Binding Protein (H-FABP) and Its Role as a Biomarker in Heart Failure: What Do We Know So Far?

Rezar

Jirak

Gschwandtner

et al. 2020

JCM

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Background: Heart failure (HF) remains one of the leading causes of death to date despite extensive research funding. Various studies are conducted every year in an attempt to improve diagnostic accuracy and therapy monitoring. The small cytoplasmic heart-type fatty acid-binding protein (H-FABP) has been studied in a variety of disease entities. Here, we provide a review of the available literature on H-FABP and its possible applications in HF. Methods: Literature research using PubMed Central was conducted. To select possible studies for inclusion, the authors screened all available studies by title and, if suitable, by abstract. Relevant manuscripts were read in full text. Results: In total, 23 studies regarding H-FABP in HF were included in this review. Conclusion: While, algorithms already exist in the area of risk stratification for acute pulmonary embolism, there is still no consensus for the routine use of H-FABP in daily clinical practice in HF. At present, the strongest evidence exists for risk evaluation of adverse cardiac events. Other future applications of H-FABP may include early detection of ischemia, worsening of renal failure, and long-term treatment planning.

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“…A low threshold for referring patients with chest complaints to secondary care is an effective strategy for the GP to avert missed cases of ACS [ 19 ]. In the Netherlands, this strategy results in 78% of referred patients that are ACS negative in the emergency room (positive predictive value (PPV) is 22%), whereas ACS is present in 5% of patients that are not referred (negative predictive value (NPV) is 95%) and the outcome is probably not severely affected by initially not referring (specificity and sensitivity of clinical assessment by GP: 55%, resp 81%) [ 6 , 20 ]. To enhance triage by a GP and reduce patient burden in secondary care, new diagnostic tools should become available [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…An earlier study in primary care evaluating a PoC-test on H-FABP did not lead to implementation of PoC-testing in daily practice because of a lack of NPV [ 20 ]. However, the PoC device for H-FABP used in this study used a cut-off value of 7 ng/ml, which is above the 99 th percentile of 5.7 ng/ml as found in a normal reference population [ 41 ].…”

Section: Introductionmentioning

confidence: 99%

The value of signs, symptoms and plasma heart-type fatty acid-binding protein (H-FABP) in evaluating patients presenting with symptoms possibly matching acute coronary syndrome: background and methods of a diagnostic study in primary care

Willemsen¹,

Buntinx

Winkens³

et al. 2014

BMC Fam Pract

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BackgroundChest complaints presented to a general practitioner (GP) are frequently caused by diseases which have advantageous outcomes. However, in some cases, acute coronary syndrome (ACS) is present (1.5-22% of cases). The patient’s signs, symptoms and electrocardiography results are insufficient diagnostic tools to distinguish mild disease from ACS. Therefore, most patients presenting chest complaints are referred to secondary care facilities where ACS is then ruled out in a majority of patients (78%). Recently, a point of care test for heart-type fatty acid-binding protein (H-FABP) using a low cut-off value between positive and negative of 4 ng/ml has become available. We aim to study the role of this point of care device in triage of patients presenting chest complaints possibly due to ACS, in primary care. Our research protocol is presented in this article. Results are expected in 2015.Methods/DesignParticipating GPs will register signs and symptoms in all patients presenting chest complaints possibly due to ACS. Point of care H-FABP testing will also be performed. Our study will be a derivation study to identify signs and symptoms that, combined with point of care H-FABP testing, can be part of an algorithm to either confirm or rule out ACS. The diagnostic value for ACS of this algorithm in general practice will be determined.DiscussionA safe diagnostic elimination of ACS by application of the algorithm can be of significant clinical relevance. Improved triage and thus reduction of the number of patients with chest complaints without underlying ACS, that are referred to secondary care facilities, could lead to a substantial cost reduction.Trial registrationClinicalTrials.gov, NCT01826994, accepted April 8th 2013.

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Diagnostic value of a heart-type fatty acid-binding protein (H-FABP) bedside test in suspected acute coronary syndrome in primary care

Abstract: The H-FABP rapid test provides modest additional diagnostic certainty in primary care. It cannot be used to safely exclude rule out ACS. The test can only be used safely in patients otherwise NOT referred to hospital by the GP, as an extra precaution not to miss ACS ('rule in').

Cited by 27 publications

References 19 publications

Evaluating possible acute coronary syndrome in primary care: the value of signs, symptoms, and plasma heart-type fatty acid-binding protein (H-FABP). A diagnostic study

Evaluating possible acute coronary syndrome in primary care: the value of signs, symptoms, and plasma heart-type fatty acid-binding protein (H-FABP). A diagnostic study

Heart-Type Fatty Acid-Binding Protein (H-FABP) and Its Role as a Biomarker in Heart Failure: What Do We Know So Far?

The value of signs, symptoms and plasma heart-type fatty acid-binding protein (H-FABP) in evaluating patients presenting with symptoms possibly matching acute coronary syndrome: background and methods of a diagnostic study in primary care

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