Kaczyñska Anna, Pelsers Maurice M A L, Bochowicz Anna, Kostrubiec Maciej, Glatz Jan F C, Pruszczyk Piotr
Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland.
Clin Chim Acta. 2006 Sep;371(1-2):117-23. doi: 10.1016/j.cca.2006.02.032. Epub 2006 May 15.
Irreversible right ventricular (RV) failure with myocardial damage may precipitate fatal outcome in acute pulmonary embolism (APE). Cytoplasmic heart-type fatty acid binding protein (H-FABP) is a sensitive and specific biomarker of myocardial damage. We assessed which biomarker of myocardial damage or RV stretching is the most useful for short-term risk stratification in APE.
We analyzed 77 patients (51 F, 26 M) aged 65.3+/-16.0 years with confirmed APE. On admission, systemic blood pressure and transthoracic echocardiography (for RV overload) were recorded and plasma concentrations of myoglobin (Mb), cardiac troponin T (cTnT), N-terminal fragment of proBNP (NT-proBNP) and H-FABP were evaluated.
Fifteen (19.5%) patients died and 24 (31.2%) experienced complicated clinical course (CCC)-death/thrombolysis/cardiopulmonary resuscitation/intravenous vasopressors. Hazard ratio analysis demonstrated that plasma H-FABP, Mb, cTnT and NT-proBNP concentrations predicted fatal outcome. When only APE-related deaths were considered, plasma H-FABP concentrations indicated fatal outcome. Multivariate hazard ratio analysis revealed H-FABP as the only 30-day mortality predictor (HR 1.02 CI 95% 1.01-1.05).
H-FABP measured on admission is useful for short-term risk stratification in APE. It appears to be superior to cTnT, NT-proBNP and Mb in the prediction of 30-day APE-related mortality.
伴有心肌损伤的不可逆性右心室（RV）衰竭可能会在急性肺栓塞（APE）中导致致命后果。细胞质心脏型脂肪酸结合蛋白（H-FABP）是心肌损伤的一种敏感且特异的生物标志物。我们评估了哪种心肌损伤或RV扩张的生物标志物对APE的短期风险分层最有用。
我们分析了77例确诊为APE的患者（51例女性，26例男性），年龄为65.3±16.0岁。入院时，记录全身血压和经胸超声心动图（用于评估RV负荷），并评估肌红蛋白（Mb）、心肌肌钙蛋白T（cTnT）、B型利钠肽原N端片段（NT-proBNP）和H-FABP的血浆浓度。
15例（19.5%）患者死亡，24例（31.2%）经历了复杂的临床病程（CCC）——死亡/溶栓/心肺复苏/静脉使用血管加压药。风险比分析表明，血浆H-FABP、Mb、cTnT和NT-proBNP浓度可预测致命结局。仅考虑与APE相关的死亡时，血浆H-FABP浓度提示致命结局。多变量风险比分析显示H-FABP是唯一的30天死亡率预测指标（HR 1.02，95%CI 1.01-1.05）。
入院时检测的H-FABP对APE的短期风险分层有用。在预测30天APE相关死亡率方面，它似乎优于cTnT、NT-proBNP和Mb。
