Heart-type fatty acid binding protein in early diagnosis of myocardial infarction in the era of high-sensitivity troponin: a systematic review and meta-analysis

Abstract

Introduction: Heart-type fatty acid binding protein (HT FABP) is an emerging biomarker of ischaemic myocardial necrosis. While previous studies have demonstrated its additive value when compared to contemporary troponin assays in the diagnosis of acute myocardial infarction (AMI), its utility in the era of high-sensitivity troponin (hsTn) assays remains undetermined. Methodology: A systematic review and meta-analysis of relevant studies was performed comparing the diagnostic performance of HT FABP both alone and in conjunction with hsTn in the early diagnosis and exclusion of AMI. Results: A systematic literature search yielded eight eligible studies including 3395 patients. Of these, 716 patients (21.1%) were eventually diagnosed with AMI. The pooled sensitivity and specificity for hsTn on admission was 82.5% (95% confidence interval [CI]: 79.8-85.0%) and 89.7% (95% CI: 88.7-90.6%), respectively, while the area under the curve (AUC) for the summary receiver operating characteristics (ROC) curve is 0.92 (SE 0.02). While the pooled specificity (84.6%, 95% CI: 83.2-85.9%) of admission HT FABP is similar to hsTn for the early diagnosis of AMI (P ¼ 0.07), its pooled sensitivity (63.5%, 95% CI: 59.9-67.1%, P < 0.001) is significantly worse. Accordingly, the AUC of the summary ROC curve for HT FABP (0.79, SE 0.03) is inferior to hsTn (P < 0.0001). The addition of HT FABP to hsTn resulted in no improvement in the sensitivity (P ¼ 0.058) and worsened the specificity (P ¼ 0.001) in the early diagnosis of AMI compared to hsTn alone. Conclusion: HT FABP does not appear to improve the diagnostic accuracy of hsTn, and consequently its routine use currently cannot not be recommended.

Heart-type fatty acid-binding protein: an overlooked cardiac biomarker

“…Similar findings were reported by Collinson et al in another large cohort of 850 low-risk patients presenting early to the ED with CP [50]. Meta-analyses seem to confirm the higher sensitivity of hs-Tn, and the relative lack of improvement with H-FABP [59,60]. However, there was significant heterogeneity among studies, and early presenters (<3-4 h from symptom-onset)the real target population for both markerswere largely missing in both analyses, still leaving questions about the utility of H-FABP in the era of hs-Tn.…”

Heparin Binding Protein in Adult Heart Surgery

“…Commercial enzyme-linked immunosorbent assay (ELISA) kits were used for measurements of HBP (Axis-Shiled Diagnostics, Dundee, UK), LF (Hycult Biotech, Uden, The Netherlands), MPO (BioLegend, San Diego, Ca, USA) and heart-type fatty acid binding protein (hFABP, Hycult Biotech, Uden, The Netherlands). Since hFABP is a rapid and sensitive biomarker of cardiomyocyte injury, it was used as a positive control biomarker for detection of transcoronary plasma concentration differences of a parameter [20]. Plasma aliquots that were not thawed previously were used for ELISA measurements.…”

“…have significance in coronary endothelial cell injury and myocardial edema formation, occurring both in experimental and clinical cardiac surgery [22,23]. Of note, coronary HPB release was accompanied with the coronary release of hFABP that is an early and sensitive biomarker of myocardial injury [20].…”

Troponin, delta change and the evolution of cardiac biomarkers – back to the future (again)

“…30 Improvement in assay sensitivity also suggests that the use of additional markers such as heart fatty acid binding protein and co-peptin 31 used to improve sensitivity in the early period following MI may not be required. 32 The advent of high-sensitivity assays capable of measuring low concentrations of troponin with good precision has resulted in evaluation of a range of strategies for rapid diagnosis 33 including single measurement on admission 34,35 and short interval serial (1-2 h) measurement strategies. 36,37 Such strategies may be difficult to realize in routine clinical practice and short sampling intervals using low level cut-offs, the 99th percentile and a delta value may be more appropriate.…”

“…30 Improvement in assay sensitivity also suggests that the use of additional markers such as heart fatty acid binding protein and co-peptin 31 used to improve sensitivity in the early period following MI may not be required. 32…”