H-FABP predicts mortality in intermediate risk pulmonary embolism
MedWire News: Heart-type fatty acid-binding protein (H-FABP) is an important prognostic indicator in patients presenting with acute, intermediate risk pulmonary embolism (PE), German research shows.
Recently, several studies have reported that H-FABP, a low-molecular- weight cytosolic protein, enables earlier, more precise diagnosis and risk assessment of acute coronary syndromes in patients presenting with acute chest pain, compared with other biomarkers, note Alessandra Boscheri (University of Technology, Dresden) and colleagues.
In the present study, Boscheri and team assessed the prognostic role of H-FABP in 101 consecutive patients (56% women, mean age 71 years) with confirmed PE and echocardiographic signs of right ventricular overload, but without shock or hypotension (intermediate risk pulmonary embolism).
Upon arrival in the emergency department, all patients were tested for plasma H-FABP using a qualitative enzyme-linked immunosorbant assay with a cut-off of 7 ng/ml, 14 (14%) had a positive result.
Of the 14 patients with positive H-FABP, 10 (71%) experienced clinical deterioration and required inotropic support during their time in hospital, and eight (57%) died. In contrast, none of the 87 patients with a negative test worsened, needed inotropic support, or died during their hospital stay.
In addition, right ventricular function on echocardiography was significantly more impaired in the H-FABP-positive group, compared with the H-FABP-negative group.
Multivariate analyses revealed that H-FABP was the only independent predictor of mortality after 6 months when compared with echocardiographic parameters and troponin I, creatine kinase (CK), CK-MB, and D-dimer levels.
Boscheri and co-authors say that H-FABP is a promising early prognostic indicator showing a high correlation with both in-hospital and 6-month mortality in patients with acute intermediate risk PE.
They add that it correlates very well with echocardiographic signs of right ventricular dysfunction and therefore permits rapid risk assessment.
In fact, when the test is positive, our study results recommend close cardiopulmonary monitoring together with immediate aggressive medical therapy, before the patient becomes unstable, conclude the researchers in the American Heart Journal.
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By Laura Dean