Giá trị tiên lượng của h FABP trong nhồi máu cơ tim cấp

1/To evaluate variation of the level of H-FABP in patients with acute myocardial infarction before 6 hours and after 24 hours.. 2/ To determine the relationship between the level of FABP

PROGNOSTIC VALUE

OF H-FABP, A NEW MARKER

IN ACUTE MYOCARDIAL INFARCTION

Dr GIAO THI THOA- Đa Nang Hopital

A/ Prof NGUYEN LAN HIEU- Ha Noi Medical University

Prof HUYNH VAN MINH- Hue University of Medicine and Pharmacy

Deaths from Cardiovascular disease have been declining in developed nations but have increased in low- and middle-income countries

Over 80% of the world's CVD deaths now occur in developing nations

Currently, heart disease is the biggest health threat to humans

Among them, AMI is one of the leading causes of death and disability

Despite the development of cardiac centers and theories of high sensitivity and specificity of biomarkers in myocardial necrosis The evaluation of unexplained chest pain symptoms remains a huge challenge

Non ACS diagnosis? Stable Angina? Unstable Angina? NSTEMI?

In order to improve the accuracy and effectiveness of diagnosis of MI, clinical researchers have discovered a new type of cardiac enzyme called H-FABP (Heart-type Fatty Acid Binding Protein)

ACS Biomarker Development

Displays an array of biomarkers of different stages of cardiac disease

H-FABP was first shown to be released from injured myocardium in 1988, after which its application as a biochemical marker has been investigated

Moriates C, Maisel A.( 2010), “The utility of biomarkers in sorting out the complex patient”, Am J Med, 123(5), pp.393-9

H-FABP is the quickest marker for diagnosis of MI in the early stage when ECG

is unclear

• H-FABP is a small, cytoplasmic protein

• Molecular weight of only 15 kDa

• 20 times more cardiac specific than Myoglobin

H-FABP has demonstrated its outstanding capabilities of sensitivity and specificity, superior to troponin, particularly in the earliest stages of 0-6 hours

Within only 30 minutes after onset of AMI, H-FABP became detectable in blood and increased very quickly

The Prognostic Value

INTRODUCTION

An increased concentration of H-FABP in the early stage after chest pain demonstrated a reliable prognostic value of death and cardiovascular events after AMI

Viswanathan K, Kilcullen N, Morrell C, Thistlethwaite SJ, Sivananthan MU, Hassan TB, Barth JH, Hall AS heart-type fatty-acid

binding-protein (H-FABP) predicts long-term mortality and re-infarction in consecutive patients with suspected acute

coronary syndrome who are troponin negative J Am Coll Cardiol 2010;55(23): 2590-8

INTRODUCTION

H-FABP contributed to providing valuable information for prognostic of AMI, independent of Troponin T, ECG and clinical tests

Kilcullen N, Viswanathan K, Das R, Morrell C, Farrin A, Barth JH, Hall AS; Heart-type fatty acid-binding protein predicts long-term mortality after acute coronary syndrome and identifies high-risk patients across the range of troponin values J Am Coll Cardiol 2007;50(21):2061-7

To learn about the application of this cardiac enzyme, our selected research topic is "Prognostic value of H-FABP, a new marker in acute myocardial infarction"

1/To evaluate variation of the level of H-FABP in patients with acute myocardial infarction before 6 hours and after 24 hours

2/ To determine the relationship between the level of FABP and Killip class & early complications in acute myocardial infarction

PATIENT SELECTION CRITERIA

The target group included:

- Patients with clinical manifestations and ECG for suspected AMI

- Hospitalized before 24 hours after symptom onset

- At Da Nang Hospital from June 2013 throughout June

2014

RESEARCH METHODOLOGY

- The prospective, cross-sectional study was applied

- Each patient was surveyed in the following process: being asked about his medical history and having clinical examinations with an aim to selecting a target group in line with the study standards

RESEARCH METHODOLOGY

- Blood tests were taken in accordance with the regulations, diagnostic steps were conducted at a reliable specialist center

- All data were recorded on paper sheets

The average length of stay at hospital was 9.65 days

Similar to the findings of some national and international studies

Risk factors Frequency (n =62) Percent (%) X ± SD

Levels of CK, CK MB, Troponin T, myoglobin,

NT pro BNP, H-FABP measured for the first time

The level of biomarkers such as Troponin, NT-proBNP, and H-FABP changed over time and was accepted as statistically significant

Levels of CK, CK MB, Troponin T, myoglobin,

NT pro BNP, H-FABP measured for the second time

The levels of biomarkers such as Troponin, NT-proBNP, and H-FABP changed over time, especially the level of H-FABP decreased at 25-36 hours

Variation of H-FABP level in patients with AMI

H-FABP became detectable very soon in serum (less than one hour) and increased rapidly in most cases The median levels of H-FABP peaked at 7-12 hours and returned to normal after 36 hours

Relationship between H-FABP level

and Killip class

The patients with Killip class I was the highest at 48.4%

The correlation between the level of H-FABP and Killip class in patients with MI was accepted statistically significant

Acute mechanical complications 2 3,2 79,95±53,6

Correlation of H-FABP and early complications

in patients with myocardial infarction

The patient with heart failure group was the highest at 38.7% The average level of H-FABP in the group with sudden death was the highest

Acute mechanical complications 2 3,2 79,95±53,6

Correlation of H-FABP and early complications

in patients with myocardial infarction

There was a correlation between the level of H-FABP and complications such as arrhythmias, heart failure, sudden death and this finding was accepted as statistically significant

No of complications Frequency (n =62) Ratio % H-FABP (X ± SD)

Correlation of H-FABP and the number

of complications in one patient

The percentage of patients without complications accounted for 38.7% and the average level of H-FABP in this group was also the lowest

The percentage of patients having four complications accounted for 12.9% and the average level of H-FABP in this group was the highest

Concentration Mortality (n=12) Non-mortality

H-FABP 180,77±68,4 103,91±29,69 <0,05

Correlation of the level of H-FABP between fatal

and non-fatal groups

The level of H-FABP of the fatal group after the treatment was higher than the group with non-fatal AMI

There was a correlation between level of H-FABP and treatment results, which was accepted as statistically significant

CONCLUSION

H-FABP has been demonstrated as the quicktest marker for the diagnosis of AMI, particularly in the earliest stages of 0-6 hours

H-FABP is valuable in prediction of severe events after onset of MI

CONCLUSION

The study results showed a positive correlation between the level of H-FABP and early complications of this disease

H-FABP increased gradually with the degree of Killip class

H-FABP also increased with the severity of the early

complications

This finding is consistent with the results of

- Kilcullen N, Viswanathan K, Das R, Farrin A, (2007)

- Viswanathan K, Kilcullen N, C Morrell, SJ Thistlethwaite (2010)

THANK YOU