Heart-type fatty acid-binding protein is more sensitive than troponin T to detect the ongoing myocardial damage in chronic heart failure patients
Heart-type fatty acid-binding protein is more sensitive than troponin T to detect the ongoing myocardial damage in chronic heart failure patients
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DOI：
10.1016/j.cardfail.2006.10.014
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发表时间：
2007-03-01
影响因子：
6
通讯作者：
Kubota, Isao
中科院分区：
文献类型：
--
作者：
Niizeki, Takeshi;Takeishi, Yasuchika;Kubota, Isao
背景资料：心脏型脂肪酸结合蛋白（H-FABP）是一种小的胞浆蛋白，当心肌损伤时释放到循环中。既往研究表明，在慢性心力衰竭（CHF）患者的静脉血样本中均可检测到HFABP和肌钙蛋白T（TnT），提示存在持续性心肌损伤（OMD）。我们假设，胞质标记物（H-EABP）是更敏感的比肌原纤维成分（TnT）在OMD在CHF.Methods和结果的检测：我们测量了血清H-FABP和TnT水平在126个连续的CHF患者在入院时，和患者随访的平均时间为474 +/- 328天。根据既往研究确定HFABP（4.3 ng/mL）和TnT（0.01 ng/mL）的临界值。在所有CHF患者中，HFABP的阳性率高于TnT（46% [58/126]对26% [33/126]，P <0.0001），在重度CHF（纽约心脏协会III/IV级）患者中，HFABP的阳性率高于TnT（69% [34/49]对47% [23/ 49]，P = 0.0121）。随访期间发生27例心脏事件。在发生心脏事件的患者中，H-EABP的检出率高于TnT（88% [24/27] vs 44% [12/27]，P = 0.0103）。93例TnT阴性患者中，H-FABP阳性33例。与H-FABP和TnT均阴性的患者相比，这些患者具有更严重的纽约心脏协会分级，更高的脑钠肽水平和更高的心脏事件发生率（36%对5%，P <0.0001）。Kaplan-Meier分析显示，TnT阴性患者中，H-FABP阳性组发生心脏事件的危险性高于H-FABP阴性组（P < .0001）。考克斯比例风险模型的多变量分析显示，H-FABP是心脏事件的唯一独立预测因子（风险比15.677，P = .0001）。H-FABP的受试者工作特征曲线下面积大于TnT（0.779 vs 0.581; P = 0.009），表明H-FABP对心脏事件的预测能力大于TnT.Conclusions：H-FABP检测OMD更敏感，可以比TnT更有效地识别高危患者。
Background: Heart-type fatty acid-binding protein (H-FABP) is a small cytosolic protein and released into the circulation when the myocardium is injured. Previous studies have demonstrated that both HFABP and troponin T (TnT) are detectable in venous blood samples in chronic heart failure (CHF) patients, suggesting the presence of ongoing myocardial damage (OMD). We hypothesized that a cytosolic marker (H-EABP) is more sensitive than a myofibrillar component (TnT) in the detection of OMD in CHF.Methods and Results: We measured serum H-FABP and TnT levels in 126 consecutive CHF patients at admission, and patients were followed-up with a mean period of 474 +/- 328 days. Cutoff values for HFABP (4.3 ng/mL) and TnT (0.01 ng/mL) were determined from previous studies. Positive rate of HFABP was higher than that of TnT in all CHF patients (46% [58/126] versus 26% [33/126], P < .0001), and in severe CHF (New York Heart Association III/IV) patients (69% [34/49] versus 47% [23/ 49], P = .0121). There were 27 cardiac events during a follow-up period. In patients with cardiac events, H-EABP was more frequently detected than TnT (88% [24/27] versus 44% [12/27], P = .0103). There were 33 patients with positive H-FABP among 93 patients with negative TnT. Those patients had more severe New York Heart Association class, higher levels of brain natriuretic peptide, and higher rates of cardiac events (36% versus 5%, P < .0001) compared with those both H-FABP and TnT were negative. Kaplan-Meier analysis demonstrated that in patients with negative TnT, positive H-FABP group had higher risk for cardiac events than negative H-FABP group (P < .0001). A multivariate analysis with Cox proportional hazard model showed that H-FABP was the only independent predictor of cardiac events (hazard ratio 15.677, P = .0001). The area under the receiver operating characteristic curve was larger for H-FABP than for TnT (0.779 versus 0.581; P = .009), suggesting that H-FABP had greater predictive capacity for cardiac events than TnT.Conclusions: H-FABP was more sensitive to detect OMD and could identify patients at high risk more effectively than TnT.