Bank Ingrid Em, Dekker Marieke S, Hoes Arno W, Zuithoff Nicolaas Pa, Verheggen Peter Whm, de Vrey Evelyn A, Wildbergh Thierry X, Timmers Leo, de Kleijn Dominique Pv, Glatz Jan Fc, Mosterd Arend
Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands Laboratory of Experimental Cardiology, University Medical Centre Utrecht, The Netherlands
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands Department of Cardiology, Isala Clinics, Zwolle, The Netherlands.
Eur Heart J Acute Cardiovasc Care. 2016 Aug;5(4):364-74. doi: 10.1177/2048872615584077. Epub 2015 Apr 23.
Timely recognition of acute coronary syndrome remains a challenge as many biomarkers, including troponin, remain negative in the first hours following the onset of chest pain. We assessed the diagnostic accuracy of heart-type fatty acid binding protein (H-FABP), a cardiac biomarker with potential value immediately post symptom onset.
Prospective monocentre diagnostic accuracy study of H-FABP bedside point of care (CardioDetect®) and ELISA tests in acute coronary syndrome suspected patients presenting within 24 hours of symptom onset to the emergency department, in addition to clinical findings, electrocardiography and the currently recommended biomarker high sensitivity troponin-T (hs-cTnT). The final diagnosis of acute coronary syndrome was adjudicated by two independent cardiologists, blinded to H-FABP results. Acute coronary syndrome was diagnosed in 149 (32.9%) of 453 unselected patients with suspected acute coronary syndrome (56% men, mean age 62.6 years). Negative predictive values were similar for H-FABP point of care and ELISA tests (79% vs. 78% respectively), but inferior to initial hs-cTnT (negative predictive value 86%). The addition of H-FABP point of care results to hs-cTnT increased the negative predictive value to 89%. In a multivariable logistic regression model, H-FABP point of care and ELISA tests yielded relevant diagnostic information in addition to clinical findings and ECG (likelihood ratio test p<0.001) and increased area under the receiver operating characteristics curve (AUC; 0.82 vs. 0.84 and 0.84). This added value attenuated, however, after inclusion of hs-cTnT in the diagnostic model (AUC 0.88).
In patients suspected of acute coronary syndrome presenting to the emergency department, H-FABP testing improves diagnostic accuracy in addition to clinical findings and electrocardiography. H-FABP, however, has no additional diagnostic value when hs-cTnT measurements are also available.
由于包括肌钙蛋白在内的许多生物标志物在胸痛发作后的最初数小时内仍为阴性，因此及时识别急性冠状动脉综合征仍然是一项挑战。我们评估了心脏型脂肪酸结合蛋白（H-FABP）的诊断准确性，这是一种在症状发作后立即具有潜在价值的心脏生物标志物。
对症状发作后24小时内到急诊科就诊的疑似急性冠状动脉综合征患者进行前瞻性单中心诊断准确性研究，检测H-FABP床旁即时检测（CardioDetect®）和酶联免疫吸附测定（ELISA），同时结合临床检查结果、心电图以及目前推荐的生物标志物高敏肌钙蛋白T（hs-cTnT）。急性冠状动脉综合征的最终诊断由两名独立的心脏病专家判定，他们对H-FABP结果不知情。在453例未经选择的疑似急性冠状动脉综合征患者中，149例（32.9%）被诊断为急性冠状动脉综合征（男性占56%，平均年龄62.6岁）。H-FABP床旁即时检测和ELISA检测的阴性预测值相似（分别为79%和78%），但低于初始hs-cTnT（阴性预测值86%）。将H-FABP床旁即时检测结果与hs-cTnT相结合，可将阴性预测值提高到89%。在多变量逻辑回归模型中，除临床检查结果和心电图外，H-FABP床旁即时检测和ELISA检测还提供了相关的诊断信息（似然比检验p<0.001），并增加了受试者操作特征曲线下面积（AUC；分别为0.82、0.84和0.84）。然而，在诊断模型中纳入hs-cTnT后，这种附加值减弱（AUC为0.88）。
对于到急诊科就诊的疑似急性冠状动脉综合征患者，H-FABP检测除临床检查结果和心电图外，还可提高诊断准确性。然而，当也可进行hs-cTnT检测时，H-FABP没有额外的诊断价值。
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