Heart type fatty acid binding protein: An overlooked cardiac biomarker.

Goel, Harsh; Melot, Joshua; Krinock, Matthew D; Kumar, Ashish; Nadar, Sunil K; Lip, Gregory Y H

Cardiac troponins (cTn) are currently the standard of carefor the diagnosis of acute coronary syndromes (ACS) in patients presenting to the emergency department (ED) with chest pain (CP). However, their plasma kinetics necessitatea prolonged ED stay or overnight hospital admission, especially in those presenting early after CP onset. Moreover, ruling out ACS in low-risk patients requires prolonged ED observationor overnight hospital admission to allow serialmeasurements of c-Tn, adding cost. Heart-type fatty acid-binding protein (H-FABP) is a novel marker of myocardial injury with putative advantages over cTn. Beingpresent in abundance in the myocellular cytoplasm, it is released rapidly (<1 hour) after onset of myocardial injury and could potentially play an important role in both earlier diagnosis of high-risk patients presenting early after CP onset, as well as in risk-stratifying low-risk patients rapidly. Like cTn, H-FABP also has a potential role as a prognostic marker in other conditions where myocardial injury occurs, such asacute congestive heart failure (CHF) and acute pulmonary embolism (PE). This review provides an overview of the evidence examining therole of H-FABP in early diagnosis and risk stratification of patients with CP and in non-ACS conditions associated with myocardial injury. Key messages:Heart type fatty acid binding protein is a biomarker that is elevated early in myocardial injuryThe routine use in the emergency department complements the use of troponins in ruling out acute coronary syndromes in patients presenting early with chest painIt also is useful in risk stratifying patients with other conditions such as heart failure and acute pulmonary embolism.