Predictive value of heart-type fatty acid-binding protein for left ventricular remodelling and clinical outcome of hypertensive patients with mild-to-moderate aortic valve diseases

Abstract

Heart-type fatty acid-binding protein (H-FABP), a marker of acute myocardial infarction and a soluble cytosolic protein, may be released following left ventricular remodelling in cardiac overloaded hearts caused by hypertension, aortic regurgitation (AR) or aortic stenosis (AS). Our aim was to investigate if H-FABP levels are associated with left ventricular remodelling and clinical outcome in hypertensive patients with AR or AS. H-FABP and brain natriuretic peptide (BNP) were measured, glomerular filtration rate (GFR) was estimated using the modification of diet in renal disease (MDRD) equation, and left ventricular dimension at systole corrected for body surface area (LVDs/BSA) and relative wall thickness (RWT) were determined by echocardiography in hypertensive patients with mild-to-moderate AR (n ¼ 78), those with mild-to-moderate AS (n ¼ 73) and those without valvular heart diseases (HT) (n ¼ 50).H-FABP levels were significantly higher in AR (4.973 ng/ml) and in AS (4.573) than in HT (3.471) and BNP (65773 pg/ml, 76775, 35722). H-FABP correlated with LVDs/BSA in AR (b ¼ 0.23, Po0.05), and RWT in AS (b ¼ 0.18, Po0.05) after adjustment for age, gender and all the other variables. AS and AR patients were prospectively followed up for cardiac events during 34719 months. A multivariate Cox hazard analysis indicated H-FABP was an independent predictor of outcome both in AR (relative risk (RR) ¼ 7.61, 95% CI ¼ 2.39-25.3) and AS (RR ¼ 13.6, 95% CI ¼ 3.27-66.9). H-FABP, associated with left ventricular remodelling, is useful in predicting clinical outcome in hypertensive patients with mild-to-moderate aortic valve diseases.

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

“…Considering patients with valvular heart disease, Iida et al showed an independent association of H-FABP with clinical outcomes in hypertensive patients with aortic valve disease. Echocardiographically determined left ventricular dimensions were signs of cardiac remodelling and correlated significantly with measured levels of H-FABP, whereas Troponin T remained below cut-off levels in all patients [21]. Mirna et al actually reported a significant reduction in H-FABP plasma concentration in 79 patients with severe aortic valve stenosis after conducting transcatheter aortic valve implantation (TAVI), indicating reduced ventricular wall stress and potential reversibility of cardiac remodeling due to valvular replacement [69].…”

“…In contrast to cardiac troponins, which are bound to the myocyte's structural apparatus, H-FABP is present as soluble protein in the cytoplasm. Therefore, the release into systemic circulation may possibly be detected more rapidly and even after minor myocardial damage [21]. Liebetrau et al, for example, report significantly increased serum levels of H-FABP already 15 minutes after iatrogenic myocardial infarction, caused by transcoronary ablation of septal hypertrophy (TASH).…”

“…Upon myocardial injury, H-FABP is rapidly released from myocytes into the systemic circulation, due to its small size and free cytoplasmic localization. Also, transient increases in sarcolemmal membrane permeability are suspected to permit H-FABP leakage into the systemic circulation [20,21]. This so-called "wounding" of myocytes was observed, even after short-term ventricular stress, and it may play an important role in diverse auto-and paracrine mechanisms in the pathogenesis of HF [20].…”

Point-of-care test of heart-type fatty acid-binding protein for the diagnosis of early acute myocardial infarction

“…In the clinical studies, serum H-FABP level is also elevated under heart failure, hypertension, aortic valve regurgitation, renal dysfunction and muscular exercise [17][18][19][20] . Our study demonstrated that H-FABP had a specificity that was slightly lower than CK-MB and cTnT, and was not superior to MYO in any time period within 12 h after onset of the symptoms.…”

Biomarkers in Aortic Stenosis: A Systematic Review

“…68 H-FABP levels correlated with relative wall thickness in a cohort of patients with mild to moderate AS and were an independent predictor of cardiac events after adjustment for indices of LV function. 69 …”