Diagnostic utility of heart type fatty acid binding protein (H-FABP) versus cardiac troponin I in myocardial infarction

K. Suresh, S. Abarna Devi, Badrinath A. K., Suresh Babu S., Saranya Nagalingam


Background: Acute myocardial infarction (AMI) management is one of the therapeutic challenges faced by the emergency physician. In the field of investigational cardiology advancements, the search of superior cardiac biomarkers has led to the discovery of sensitive biomarkers which help in the early confirmation of MI as timely intervention is the primary goal in acute coronary syndrome (ACS). Present study was aimed to evaluate the diagnostic performance of the novel biomarker H- FABP in patients with AMI especially in ST elevation MI (STEMI) and comparison of its diagnostic accuracy with the other biomarkers.

Methods: We studied 66 patients with persistent STEMI presenting within 12 hours of symptom to the department of General Medicine, Sri Manakula Vinayagar Medical College and Hospital (SMVMCH), Puducherry. Quantitative and qualitative estimation and analysis of serum biomarkers of acute myocardial infarction such as CK-MB, cardiac Troponin I (cTnI) and H-FABP were done.

Results: The sensitivity and specificity of H-FABP were 80.7 and 88.9% respectively. The positive percentage of the serum biomarkers among these patients were 64%, 65%, 86% for CK-MB, cardiac troponin I, and H-FABP respectively. The area under the curve was observed to be 0.695, with 95% confidence interval (0.514-0.876) at the optimum cut-off value of 7.0ng/ml for H-FABP.

Conclusions: H-FABP the novel biomarker, because of its early appearance in the blood stream and due to its superior sensitivity and specificity compared to Troponin I and CK-MB can be used in the early diagnosis of acute ST elevation Myocardial Infarction.


Acute coronary syndrome, Cardiac troponin cTnI, Heart specific fatty acid binding protein, ST elevation myocardial infarction

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Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD et al. Third universal definition of myocardial infarction. Circulation. 2012 Oct 16; 126(16):2020–35.

Morrow DA, Cannon CP, Jesse RL, Newby LK, Ravkilde J, Storrow AB et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical characteristics and utilization of biochemical markers in acute coronary syndromes. Circulation. 2007 Apr 3;115(13):e356-75.

Figiel Ł, Wraga M, Bednarkiewicz Z, Lipiec P, Smigielski J, Krzemińska-Pakuła M, et al. Direct comparison of the diagnostic value of point-of-care tests detecting heart-type fatty acid binding protein or glycogen phosphoryl aseiso enzyme BB in patients with acute coronary syndromes with persistent ST-segment elevation. Kardiol Pol. 2011;69(1):1-6.

Andrus B, Lacaille D. 2013 ACC/AHA guideline on the assessment of cardiovascular risk. J Am Coll Cardiol. 2014 Jul;63(25 Pt A):2886.

Sgarbossa EB, Pinski SL, Barbagelata A, Underwood DA, Gates KB, Topol EJ, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators. N Engl J Med. 1996 Feb;334(8):481-7.

Bozbas H, Yildirir A, Muderrisoglu H. Cardiac enzymes, renal failure and renal transplantation. Clin Med Res. 2006 Mar;4(1):79-84.

Glatz JF, Luiken JJ, van Nieuwenhoven FA, Van der Vusse GJ. Molecular mechanism of cellular uptake and intracellular translocation of fatty acids. Prostaglandins Leukot Essent Fatty Acids. 1997 Jul;57(1):3-9.

Chauhan S, Aeri BT. Prevalence of cardiovascular disease in India and its economic impact-A review. Int J Scient Res Public. 2013 Oct;3(10):2250-3153.

Chauhan S, Aeri BT. The rising incidence of cardiovascular diseases in India. J Prevent Cardiol. 015;4(4).

Glatz JF, Luiken JJ, van Nieuwenhoven FA, Van der Vusse GJ. Molecular mechanism of cellular uptake and intracellular translocation of fatty acids. Prostaglandins Leukot Essent Fatty Acids. 1997 Jul;57(1):3-9.

Chan CPY, Sanderson JE, Glatz JFC, Cheng WS, Hempel A, Renneberg R. A superior early myocardial infarction marker. Human heart-type fatty acid-binding protein. Z FürKardiologie. 2004 May;93(5):388-97.

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 2015 Jan 27;131(4):e29-322.

Okamoto F, Sohmiya K, Ohkaru Y, Kawamura K, Asayama K, Kimura H, et al. Human heart-type cytoplasmic fatty acid-binding protein (H-FABP) for the diagnosis of acute myocardial infarction. Clinical evaluation of H-FABP in comparison with myoglobin and creatine kinase isoenzyme MB. Clin Chem Lab Med. 2000 Mar;38(3):231-8.

Kleine AH, Glatz JF, Van Nieuwenhoven FA, Van der Vusse GJ. Release of heart fatty acid-binding protein into plasma after acute myocardial infarction in man. Mol Cell Biochem. 1992 Oct;116(1-2):155-62.

Gururajan P, Gurumurthy P, Nayar P, Srinivasa Nageswara Rao G, Babu S, Cherian KM. Heart fatty acid binding protein (H-FABP) as a diagnostic biomarker in patients with acute coronary syndrome. Heart Lung Circ. 2010 Nov;19(11):660-4.

Mad P, Domanovits H, Fazelnia C, Stiassny K, Russmüller G, Cseh A, et al. Human heart-type fatty-acid-binding protein as a point-of-care test in the early diagnosis of acute myocardial infarction. QJM Mon J Assoc Physicians. 2007 Apr;100(4):203-10.

McCann CJ, Glover BM, Menown IBA, Moore MJ, McEneny J, Owens CG, et al. Novel biomarkers in early diagnosis of acute myocardial infarction compared with cardiac troponin T. Eur Heart J. 2008 Dec;29(23):2843-50.

de Lemos JA, Antman EM, Morrow DA, Llevadot J, Giugliano RP, Coulter SA, et al. Heart-type fatty acid binding protein as a marker of reperfusion after thrombolytic therapy. Clin Chim Acta Int J Clin Chem. 2000 Aug;298(1-2):85-97.

Kim Y, Kim H, Kim S-Y, Lee HK, Kwon HJ, Kim YG, et al. Automated heart-type fatty acid-binding protein assay for the early diagnosis of acute myocardial infarction. Am J Clin Pathol. 2010 Jul;134(1):157-62.

Ruzgar O, Bilge AK, Bugra Z, Umman S, Yilmaz E, Ozben B, et al. The use of human heart-type fatty acid-binding protein as an early diagnostic biochemical marker of myocardial necrosis in patients with acute coronary syndrome, and its comparison with troponin-T and creatine kinase-myocardial band. Heart Vessels. 2006 Sep;21(5):309-14.