The Role Of Heart-type Fatty Acid-binding Protein(H-FABP) In The Diagnosis Of Acute Coronary Syndrome

1.Background and research purposes:As China's economic development and improvement of living standards, cardiovascular diseases are receiving more and more attention, especially in recent years the incidence of acute myocardial infarction, as well as the increasing incidence of patients with younger age, attracted universal attention.Early rapid diagnosis and timely reperfusion treatment can save dying myocardium, the time become a decisive key to the success of reperfusion therapy. Increase the importance of such patients with chest pain, observation and risk stratification, to make the right choice to determine the appropriate treatment, can make some patients' conditions stable or reverse.A large number of clinical practice shows that about 30% of AMI patients without clinical symptoms, about 25% of AMI patients without obvious abnormality of the electrocardiogram, so biological and chemical detection in the diagnosis of AMI is particularly important. ESC and ACC suggested that it is necessary to take cardiac markers detecting abnormal changes in the diagnosis of AMI as a condition for acute attack together in 1999. At present, biological and chemical detection of commonly used as clinical indicators are cardiac troponin I (cTn), creatine kinase isoenzyme (CK-MB) and myoglobin (MYO), however, cTnI and CK-MB released into the blood late , MYO is lack of cardiac-specificity, so it is not satisfactory for them as the early diagnosis of AMI. Heart-type fatty acid binding protein (H-FABP) appears in the blood early, and have high specificity,it can be a detection of the specific indicators of myocardial infarction. This test is mainly a method with qualitative analysis and quantitative detection which takes H-FABP compared with troponin I (cTnI), creatine kinase isoenzyme (CK-MB) and myoglobin (MYO),and investigates whether the H - FABP has more advantages than other indicators in the early diagnosis of AMI, and has enough clinical value. 2.Research Methods:We take 113 patients with chest pain within 6 hours , all patients with chest pain are at the basis of clinical performance of the dynamic observation of ECG, biochemical markers of myocardial or coronary angiography examination and diagnosed as follows:(1) acute myocardial infarction group: a total of 49 cases, of which 31 men, 18 women;(2) unstable angina group: a total of 34 cases, of which 21 men, 13 women;(3) Non-cardiac chest pain group: a total of 30 cases, of which 17 men, 13 women, including all chest pain except angina.(4) non-acute myocardial infarction group: including unstable angina group and non-cardiac chest pain group. Heart-type fatty acid binding protein (H-FABP) using the method of qualitative analysis, qualitative analysis of the normal subjects and incidence of chest pain groups' heart-type fatty acid binding protein in plasma in no more than 3 hours or more than 3 hours but less than 6 hours and at the same time the laboratory of professionals make troponin I (cTnI), creatine kinase isoenzyme (CK-MB) and myoglobin (MYO) quantitative testing, compared with heart-type fatty acid binding protein (H-FABP). Our experimental comparison mainly base on 4 clinical performances,sensitivity, specificity, positive predictive value, negative predictive value,. SPSS13.0 software is used to analyze all data. Mean±standard deviation are used to express measurement data;age is tested by t test ;difference of sensitivity and specificity of 4 biochemical markers is analysed by chi-square test .3.Results:(1)28 cases of non-AMI patients in 0-3 hours , There is no significant difference that H-FABP's negative rate (specificity) 0-3 hours is (92.9%) in compared with cTnI, CK-MB and MYO(100.0 %, 92.9%, 92.9% p> 0.05); 36 cases of non-AMI patients in 3-6 hours , H-FABP's negative rate (specificity) is (100.0%) superrior than CK-MB and MYO (80.6% , 72.2% p <0.05) but cTnI was no significant difference from H-FABP(97.2% p> 0.05);64 cases of non-AMI patients in 0-6 hours , H-FABP's negative rate (specificity) is (96.9%) superior to CK-MB and MYO (85.9%, 81.2% p<0.05) but cTnI was no significant difference from H-FABP(98.4% p> 0.05).(2) 31 cases of myocardial infarction patients in 0-3 hours , H-FABP's sensitivity (25.8%) is no significant difference from CK-MB and cTnI (25.8%, 29.0% p> 0.05) ,but worse than MYO ( 74.2% p <0.05); 18 cases of myocardial infarction patients in 3-6 hours , H-FABP's sensitivity (61.1%) compared with cTnI, CK-MB and MYO was no significant difference (72.2%, 77.8%, 77.8% p> 0.05);49 cases of myocardial infarction patients in 0-6 hours, H-FABP's sensitivity (38.8%) compared with cTnI and CK-MB was no significant difference (44.9%, 44.9% p> 0.05 ) ,but poor than MYO(75.5% p<0.05).(3) H-FABP's positive predictive value in 0-3 hours is 80.0% , positive predictive value in 0-6 hours is 90.5%, there is no significant difference compared with other biochemical indicators.H-FABP's positive predictive value in 3-6 hours is 100.0%, compared with CTnI and CK-MB,there is no significant difference, but worse than MYO.(4)H-FABP's negative predictive value in 3-6 hours is 83.7% ,negative predictive value in 0-6 hours is 67.4%, compared with other biochemical indicators,is no significant difference . H-FABP's negative predictive value in 0-3 hours is 53.1%, compared with CTnI and CK-MB,was no significant difference, but worse than MYO.(5)H-FABP is no difference between the unstable angina group and non-cardiac chest pain group,positive rate (10%, 6% p> 0.5) in 0-3 hours; H-FABP is no difference between unstable angina group and non-cardiac chest pain group, positive rate (0%, 0% p> 0.5) in 3-6 hours; H-FABP is no difference between unstable angina group and non-cardiac cardiac chest pain group,positive rate (3%, 3% p> 0.5) in 0-6 hours .4.Conclusions:According to preliminary research results, H-FABPhas good specificity in the early diagnosis of AMI,specificity of 3-6 hours and 0-6 hours is superior to CK-MB and MYO, there is no significant difference with cTnI,specificity in 0-3 hours was no significant difference with cTnI, CK-MB and MYO;sensitivity in 0-3 hours and 0-6 hours is worse than MYO,no difference with cTnI and CK-MB sensitivity in 3-6 hours is no significant difference with cTnI, CK-MB and MYO.H-FABP has a higher positive predictive value in the early diagnosis of AMI,positive predictive value in 3-6 hours increased 100.0%, in favor of the exclusion and diagnosis of non-myocardial infarction patients, and it's easy to operate, and we can get outcomes in 15 minutes, the outcomes can be used for filter and diagnosis of AMI or as testing supporting indicators of diagnosis of early AMI (onset within 6 hours) .