Thielmann Matthias, Pasa Susanne, Holst Torulv, Wendt Daniel, Dohle Daniel-Sebastian, Demircioglu Ender, Sharma Vikram, Jakob Heinz
Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
Ann Thorac Surg. 2017 Jul;104(1):130-137. doi: 10.1016/j.athoracsur.2016.10.051. Epub 2017 Feb 9.
Heart-type fatty acid binding protein (hFABP) and ischemia-modified albumin (IMA) have been put forward as novel biomarkers to detect myocardial injury shortly after onset of ischemia. We compared hFABP and IMA with cardiac troponin I (cTnI) for speed and reliability in the diagnosis of perioperative myocardial infarction (PMI) after coronary artery bypass graft surgery (CABG).
In all, 210 consecutive patients undergoing isolated CABG with cardiopulmonary bypass were enrolled in a prospective study. Blood samples were taken perioperatively and throughout the first 72 hours after surgery; clinical data and events were recorded. In cohort A, serum concentrations of hFABP and cTnI were measured using a combined quantitative bedside assay. In cohort B, IMA and cTnI serum concentrations were measured using an albumin cobalt binding test. Perioperative myocardial infarction was defined using a cTnI cutoff of greater than 10.5 ng/mL occurring within 24 hours of CABG or new electrocardiographic changes.
In cohort A, 14 patients were identified with PMI (group 1), whereas 94 had no PMI and served as controls (group 2). Both hFABP and cTnI were increased in group 1 as compared with group 2 (p < 0.001). Although cTnI did not differ before 12 hours, hFABP diverged much earlier, at 1 hour postoperatively (p < 0.001). An hFABP concentration of 20 μg/mL at 1 hour detected PMI with an area under the curve of 77.1%. In cohort B, 18 patients were identified with PMI (group 3), and 84 patients served as controls (group 4). No difference in cTnI values could be observed between the groups until 12 hours postoperatively. Ischemia-modified albumin failed to differentiate at any postoperative time point; the low discriminative power of IMA was confirmed with an area under the curve of 53.3% at 1 hour, 48.5% at 6 hours, and 39.3% at 12 hours postoperatively.
Heart-type fatty acid binding protein is a sensitive and rapid biomarker that detected PMI reliably at 1 hour after CABG, much earlier than cTnI. The diagnostic value of IMA for detection of PMI appears to be very limited in this setting.
心型脂肪酸结合蛋白（hFABP）和缺血修饰白蛋白（IMA）已被提出作为在缺血发作后不久检测心肌损伤的新型生物标志物。我们将hFABP和IMA与心肌肌钙蛋白I（cTnI）在冠状动脉旁路移植术（CABG）后围手术期心肌梗死（PMI）诊断中的速度和可靠性进行了比较。
总共210例接受体外循环下单纯CABG的连续患者纳入一项前瞻性研究。在围手术期及术后前72小时内采集血样；记录临床数据和事件。在队列A中，使用联合定量床边检测法测量hFABP和cTnI的血清浓度。在队列B中，使用白蛋白钴结合试验测量IMA和cTnI的血清浓度。围手术期心肌梗死的定义为CABG后24小时内cTnI临界值大于10.5 ng/mL或出现新的心电图变化。
在队列A中，14例患者被诊断为PMI（第1组），而94例无PMI患者作为对照（第2组）。与第2组相比，第1组的hFABP和cTnI均升高（p < 0.001）。虽然cTnI在12小时前无差异，但hFABP在术后1小时就出现明显差异（p < 0.001）。术后1小时hFABP浓度为20 μg/mL时检测PMI的曲线下面积为77.1%。在队列B中，18例患者被诊断为PMI（第3组），84例患者作为对照（第4组）。术后12小时前两组cTnI值无差异。缺血修饰白蛋白在术后任何时间点均无法区分；IMA的低鉴别能力在术后1小时曲线下面积为53.3%、6小时为48.5%、12小时为39.3%时得到证实。
心型脂肪酸结合蛋白是一种敏感且快速的生物标志物，在CABG后1小时就能可靠地检测到PMI，比cTnI早得多。在这种情况下，IMA对PMI检测的诊断价值似乎非常有限。
