QUALITATIVE TEST FOR THE FATTY ACID BINDING CARDIAC PROTEIN IN EARLY DIAGNOSTICS OF MYOCARDIAL INFARCTION: SUBANALYSIS OF RUSSIAN MULTI-CENTER STUDY ISPOLIN

Aim. To specify diagnostic characteristics of the test for qualitative measurement of the fatty acid binding protein, cardiac fraction (cFABP), in patients with suspected acute coronary syndrome (ACS) based on the subanalysis of ISPOLIN study.

Material and methods. To the subanalysis, 592 patients included, admitted to inpatient institutions of 8 centers in 5 cities, with suspected ACS during 24 hours from the onset of clinical signs. At admittance, all patients underwent cFABP test in whole venous blood with immune chromatography express test “CardioFABP” (SPI “Biotest”, Novosibirsk, Russia) and level of cardiac troponin I by qualitative and quantitative methods. For both markers, the values were assessed of sensitivity, specificity, diagnostic accuracy, positive and negative predictive value in general, and various timing intervals from the moment of clinical ACS signs presentation and ECG changes.

Results. During first 6 hours from the pain onset, cFABP test performed better than cTnI by sensitivity, diagnostic accuracy and negative predictive significane (p<0,01), and no worse than specificity and positive predictive value (p>0,05). With the pain less than 3 hours and 3-6 hours, ROC areas for cFABP are better than those for cTnI. With the duration of clinical signs more than 6 hours, sensitivity and diagnostic accuracy were better than of cTnI. In anamnesis of the patients with false positive results of cFABP test there were kidney diseases and anemia. They also had GFR <30 mL/min/1,73 m² at admission and higher in-hospital mortality (p<0,01).

Conclusion. Qualitative express-test “CardioFABP” makes it to more accurately diagnose MI at early stages of the disease comparing to cTnI. The test might be useful in cases when MI diagnostics is complicated or if there are no ways to measure levels of troponins.

1. Statisticalinformation. (InRuss.) Статистическая информация Минздрава России. https://www.rosminzdrav.ru/ministry/61/22/stranitsa-979/statisticheskaya-informatsiyaminzdrava-rossii).

2. El Missiri A, Okasha N, Badr T. Heart-type fatty acid-binding protein detects more patients with non-ST segment elevation myocardial infarction compared to troponin-T. Egypt Heart J 2016; 68 (1): 11-6. DOI: 10.1016/j.ehj.2015.09.002.

3. McCann CJ, Glover BM, Menown IB, et al. Novel biomarkers in early diagnosis of acute myocardial infarction compared with cardiac troponin T. European Heart Journal 2008; 29 (23): 2843-50. DOI: 10.1093/eurheartj/ehn363.

4. Pyati A K, Devaranavadagi BB, Sajjannar SL, et al. Heart-type fatty acid binding protein: a better cardiac biomarker than CK-MB and myoglobin in the early diagnosis of acute myocardial infarction. J Clin Diagn Res 2015; 9 (10): BC08-11. DOI: 10.7860/JCDR/2015/15132.6684.

5. Hamm CW, Bassand J-P, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal 2011; 32: 2999-3054. DOI: 10.1093/eurheartj/ehr236.

6. Yarokhno NN, Bolshakova IA, Balabushevich AV, et al. Effectiveness assessment of early risk stratification using cardiac binding protein fatty acid in patients with suspected acute coronary syndrome without ST-segment elevation in emergency ambulance conditions. Vrach skoroj pomoshhi 2013, 6: 21-5. (In Russ.) Ярохно Н.Н., Большакова И.А., Балабушевич А.В. и др. Оценка эффективности ранней стратификации риска с применением сердечного белка, связывающего жирные кислоты, у больных с подозрением на острый коронарный синдром без подъема сегмента ST в условиях скорой медицинской помощи. Врач скорой помощи 2013, 6: 21-5.

7. O’Donoghue M, de Lemos JA, Morrow DA, et al. Prognostic utility of heart-type fatty acid binding protein in patients with acute coronary syndromes. Circulation 2006; 114: 550-7. DOI: 10.1161/CIRCULATIONAHA.106.641936.

8. Chandran PA, Wani BA, Satish OS, Mohammed N. Diagnosis of non-ST-elevation acute coronary syndrome by the measurement of heart-type fatty acid binding protein in serum: a prospective case control study. J Biomark 2014; 2014: Article ID 624930, 9 pages. DOI: 10.1155/2014/624930.

9. Carroll C, Al Khalaf M, Stevens JW, et al. Heart-type fatty acid binding protein as an early marker for myocardial infarction: systematic review and meta-analysis. Emerg Med J 2013; 30 (4): 280-6. DOI: 10.1136/emermed-2012-201174.

10. Abbasi WA, Saleem M, Rasheed S, Kiyani AM. Utility of heart type fatty acid binding protein (H-FABP) point of care test in the early hours of STEMI compared with troponin-I in Pakistani population. J Ayub Med Coll Abbottabad 2017; 29 (1): 107-11.

11. Çavuşoğlu Y, Gök B, Demirüstü C, et al. Diagnostic value of heart-type fatty acid binding protein determined by the rapid qualitative chromatographic immunoassay method for the detection of minor myocardial damage in patients presenting with non-ST elevation acute coronary syndrome. Anadolu Kardiyol Derg 2012; 12 (7): 584-90. DOI: 10.5152/akd.2012.185.

12. Gerede DM, Güleç S, Kiliçkap M, et al. Comparison of a qualitative measurement of hearttype fatty acid-binding protein with other cardiac markers as an early diagnostic marker in the diagnosis of non-ST-segment elevation myocardial infarction. Cardiovasc J Afr 2015; 26 (6): 204-9. DOI: 10.5830/CVJA-2015-028.

13. Kalinichenko RM, Kopylov FYu, Syrkin AL, et al. The results of application of the rapid quantitative assay for fatty acid-binding protein at the onset of acute coronary syndrome. Klinicheskaya Meditsina 2013, 1: 32-7. (In Russ.) Калиниченко Р.М., Копылов Ф.Ю., Сыркин А.Л. и др. Результаты применения качественного экспресс-теста на белок, связывающий жирные кислоты, у пациентов в ранние сроки острого коронарного синдрома. Клиническая медицина 2013, 1: 32-7.

14. GolovenkinSE, ShulmanVA, PelipetskayaEYu, etal. Possibilities of “CardioBSZHK” express-test in case of acute myocardial infarction diagnostics. Vrach skoroj pomoshhi 2011, 11: 25-30. (In Russ.) Головенкин С. Е., Шульман В.А., Пелипецкая Е.Ю. и др. Возможности экспресс-теста “КардиоБСЖК” при диагностике острого инфаркта миокарда. Врач скорой помощи 2011, 11: 25-30.

15. PlavunovNF, KadyshevVA, SokolovAYu, etal. Approbation of the express-test “CardioFABP” in practice of the emergency medical service for the differential diagnosis of acute coronary syndrome. Emergency medical care 2014, 4: 31-6. (In Russ.) (Плавунов Н.Ф., Кадышев В.А., Соколов А.Ю. и др. Апробация теста “КардиоБСЖК” в практике скорой медицинской помощи при дифференциальной диагностике острого коронарного синдрома. Скорая медицинская помощь 2014, 4: 31-6).

16. Martynov AI, Voevoda MI, Arutyunov GP, et al. Clinical effectiveness of early acute myocardial infarction diagnostics, based on the assessment of cardiac fatty acid binding protein levels. Russ J Cardiol 2012, 3: 7-11. (InRuss.) Мартынов А.И., Воевода М.И., Арутюнов Г. П. и др. Клиническая эффективность ранней диагностики острого инфаркта миокарда с помощью белка, связывающего жирные кислоты. Российский кардиологический журнал 2012, 3: 7-11.