Cardiovascular Journal of Africa: Vol 26 No 6 (November/December 2015)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 6, November/December 2015

204

AFRICA

Cardiovascular Topics

Comparison of a qualitative measurement of heart-type

fatty acid-binding protein with other cardiac markers as

an early diagnostic marker in the diagnosis of non-ST-

segment elevation myocardial infarction

Demet Menek

e Gerede, Sadi Güleç, Mustafa Kılıçkap, Cansın Tulunay Kaya, Veysel Kutay Vurgun,

Özgür Ula

Özcan, Hüseyin Göksülük, Çetin Erol

Abstract

Objective:

Heart-type fatty acid-binding protein (H-FABP)

is a novel cardiac marker used in the early diagnosis of acute

myocardial infarction (AMI), which shows myocyte injury.

Our study aimed to compare bedside H-FABP measurements

with routine creatine kinase-MB (CK-MB) and troponin I

(TnI) tests for the early diagnosis of non-ST-elevation MI

(NSTEMI), as well as for determining its exclusion capacity.

Methods:

A total of 48 patients admitted to the emergency

room within the first 12 hours of onset of ischaemic-type

chest pain lasting more than 30 minutes and who did not have

ST-segment elevation on electrocardiography (ECG) were

included in the study. Definite diagnoses of NSTEMI were

made in 24 patients as a result of 24-hour follow up, and the

remaining 24 patients did not develop MI.

Results:

When various subgroups were analysed according to

admission times, H-FABP was found to be a better diagnostic

marker compared to CK-MB and TnI (accuracy index 85%),

with a high sensitivity (79%) and specificity (93%) for early

diagnosis (

≤

six hours). The respective sensitivities of bedside

H-FABP and TnI tests were 89 vs 33% (

0.05) for patients

presenting within three hours of onset of symptoms.

Conclusion:

Bedside H-FABP measurements may contribute

to correct early diagnoses, as its levels are elevated soon

following MI, and measurement is easy, with a rapid result.

Keywords:

acute coronary syndrome, non-ST-elevation myocar-

dial infarction, H-FABP, CK-MB, troponin

Submitted 26/11/14, accepted 16/3/15

Published online 14/7/15

Cardiovasc J Afr

2015;

: 204–209

www.cvja.co.za

DOI: 10.5830/CVJA-2015-028

Acute coronary syndrome (ACS) defines the clinical conditions

that develop as a result of an abrupt reduction in coronary

blood flow. Unstable angina pectoris (UAP), ST-elevation

acute myocardial infarction (STEMI), and non-ST-elevation

acute myocardial infarction (NSTEMI) are points on this

clinical spectrum. All these clinical syndromes should be rapidly

diagnosed and treated.

1,2

Chest pain contributes to 50% of emergency room admissions

and approximately 25% of these patients are hospitalised.

Patients with ACS are usually admitted with chest pain. Studies

have shown that the final diagnoses of patients admitted with

chest pain are acute myocardial infarction (AMI) in one-third

of patients, UAP in one-third, and non-cardiac chest pain in

one-third.

Early diagnosis of acute chest pain is especially important

and difficult in patients without persistent ST-segment elevation.

Electrocardiography (ECG) is a valuable and commonly used

test for the detection of ACS. The initial ECG is normal

or non-diagnostic in 50% of patients with ACS.

STEMI is

readily diagnosed with culprit ECG findings but NSTEMI/

UAP diagnoses are more challenging. Inadequate and delayed

diagnoses may lead to inappropriate treatment and delays in the

initiation of life-saving therapy.

Diagnostic criteriaof AMIwere reformedafter the introduction

of more sensitive and specific markers for cardiac injury (cardiac

troponins, CK-MB mass) and after a better understanding of

the diagnostic and prognostic importance of these markers. In

the 2012 report of the European Society of Cardiology (ESC)/

American College of Cardiology (ACC), the essential criterion

for MI was defined as elevated cardiac markers.

Heart-type fatty acid-binding protein (H-FABP) is a recently

discovered cardiac biomarker. It is specific to cardiomyocytes

and low-molecular weight (15 kDa) cytosolic proteins, which

represent five to 15% of the cytosolic proteins of cardiac

myocytes.

H-FABP plays an important role in intracellular

transport for

-oxidation of fatty acids in the mitochondria.

8,9

Department of Cardiology, Ankara University School of

Medicine, Ankara, Turkey

Demet Menek

e Gerede, MD,

drmeneksegerede@yahoo.com

Sadi Güleç, MD

Mustafa Kılıçkap, MD

Cansın Tulunay Kaya, MD

Veysel Kutay Vurgun, MD

Özgür Ula

Özcan, MD

Hüseyin Göksülük, MD

Çetin Erol, MD