Elsevier

American Heart Journal

Volume 160, Issue 2, August 2010, Pages 294-300
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Correlation of heart-type fatty acid–binding protein with mortality and echocardiographic data in patients with pulmonary embolism at intermediate risk

https://doi.org/10.1016/j.ahj.2010.05.010Get rights and content

Background

The management strategy in patients presenting with pulmonary embolism at intermediate risk still remains controversial. Our aim was to determine the role of heart-type fatty acid–binding protein (H-FABP) in this patient population.

Methods

One hundred one consecutive patients with confirmed pulmonary embolism and echocardiographic signs of right ventricular overload but without evidence for hypotension or shock, referred to as pulmonary embolism at intermediate risk, were included in the study. Heart-type fatty acid–binding protein and other biomarkers were measured in all patients upon arrival in the emergency department.

Results

Of the included 101 patients, 14 had positive H-FABP tests. Ten patients with positive H-FABP (71%) had clinical deterioration during the hospital course and required inotropic support and 8 of these patients died. None of the 87 patients with a negative test worsened or needed inotropic support or died during hospital stay (P < .005). In the H-FABP–positive group, right ventricular function on echocardiography was more impaired (tricuspid annular plane systolic excursion 13 ± 4 vs 18 ± 4 mm, RV/LV ratio 1.1 ± 0.2 vs 0.9 ± 0.2, presence of paradoxical septal movement 79% vs 46%, presence of McConnell sign 100% vs 60%, respectively, all P < .05) compared to the H-FABP–negative group. After adjusting for potential confounding parameters, in multivariate analysis, H-FABP was the only independent predictor of mortality.

Conclusions

Heart-type fatty acid–binding protein significantly predicts mortality in patients with pulmonary embolism at intermediate risk. Furthermore, it is significantly associated with impaired right ventricular function and shows better correlation with mortality than troponin I. It may be a novel prognostic parameter enabling the optimization of management strategy in the very difficult population of pulmonary embolism at intermediate risk.

Section snippets

Study population and design

A total of 101 consecutive patients (57 women, 44 men, mean age 71 ± 12 years) with confirmed acute PE were prospectively included in this trial over a period of 36 months. Acute PE was confirmed by computed tomography scan. Pulmonary embolism was classified according to the new PE guidelines by the European Society of Cardiology in the following severity levels: high-risk and non–high-risk PE, whereas non–high risk is further classified in low-risk and intermediate-risk PE.15 Only patients

Baseline demographics

One hundred one patients were included in the study with a mean age of 70 ± 13 years. Heart-type fatty acid–binding protein was elevated (≥7 ng/mL) in 14 (14%) of the 101 patients. The baseline characteristics of the study population showed no statistical difference between the group with elevated and the group with normal H-FABP levels (Table I).

Clinical presentation

Of the 101 patients included, according to the inclusion criteria, none needed vasopressor support on admission, which would have been needed if

Discussion

Despite important advances in diagnosis and risk stratification, PE remains an underdiagnosed clinical entity with potentially life-threatening complications. Showing a correlation with in-hospital mortality, both echocardiography and biomarkers such as troponins have become indispensable tools in the management of patients with PE.7, 22 Recently, H-FABP has drawn attention as an additional biomarker showing a strong correlation to mortality in coronary patients,10, 13, 14 and in patients with

Conclusion

Heart-type fatty acid–binding protein is a promising and very early parameter showing a high correlation with both in-hospital 30-day and 6-month mortality in patients with acute PE at intermediate risk. It correlates very well with echocardiographic signs of RV dysfunction and therefore permits rapid risk assessment. Being an easy available test, it should be performed routinely on admission when PE is suspected to better risk-stratify patients.

Disclosures

Conflicts of interest: none.

No funding has been obtained for this study.

Acknowledgements

All authors significantly contributed to this work. The corresponding author states that she had full access to all of the data in the study and she takes full responsibility for the integrity of all of the data and the accuracy of the data analysis.

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