Abstract: P2602

Heart fatty acid binding protein in patients hospitalized because of worsening heart failure. Relation to prognosis of death

Authors:
I.R. Trifonov¹, O.L. Mazovets¹, A.H. Katrukha², A.V. Bereznikova², M.V. Medvedeva², A.D. Deev¹, N.A. Gratsiansky¹, ¹Institute of Physico-Chemical Medicine - Moskva - Russian Federation, ²Moscow State University - Moskva - Russian Federation,

Topic(s):
Prognosis

Citation:
European Heart Journal ( 2007 ) 28 ( Abstract Supplement ), 417

Purpose: We tested the hypothesis that serum heart fatty-acid binding protein (FABP), an early marker of myocardial necrosis, is related to prognosis of patients (pts) hospitalized because of worsening heart failure (HF).

Methods: Sixty nine pts (64% men, age 66.6±11.0 years) with NYHA class II, III, IV HF (1, 18, and 50 pts, respectively) at hospital admission were followed for 6-12 (mean 11.6±1.3) months. Forty seven pts (68.1%) had history of myocardial infarction (MI), 56 (81.2%) - hypertension, 15 (21.7%) – diabetes, and 17 (24.6%) had echocardiographical signs of aortic stenosis. Median left ventricular ejection fraction was 28%. Serum FABP, cardiac troponin I (Tn I) and N-aminoterminal pro brain natriuretic peptide (NT proBNP) were measured within 3 days after admission ("admission" levels) and two weeks later (minimal hospital stay). Manufacturer recommended upper limits of norm (ULN) were 4.0 ng/ml for FABP, 0.35 ng/ml for Tn I, 0.1 ng/ml for NT proBNP.

Results: Median admission FABP was insignificantly higher than level measured 2 weeks later (4.17 vs 4.03 ng/ml, p=0.069). FABP exceeded ULN in 38 (55.1%) pts and in 35 (50.7%) pts at admission and in 2 weeks, respectively (p=0.65). Median admission NT proBNP was significantly higher than 2 weeks level (13.23 vs 6.02 ng/ml, p<0.0001). Median admission and 2-weeks levels of Tn I were similar and greatly lower than ULN. There were 27 all cause deaths (39.1%) during follow up. Median admission levels of TnI, FABP and NT proBNP were similar in pts who died and survived. Two weeks NT proBNP was significantly higher in pts who died (8.65 vs 3.62 ng/ml, p=0.012). ROC curve derived cut-off levels of FABP and NT proBNP (3.31 ng/ml and 3.5 ng/ml, respectively) were used in univaritate regression analysis. According to this analysis FABP ≥3.31 ng/ml was related to occurrence of death (OR 3.54; 95% CI 1.03-12.17, p=0.044). FABP and variables with p >0.1 (age, history of MI and diabetes, regular treatment with nitrates, signs of aortic stenosis, pulmonary rales at admission, and 2 weeks level of NT proBNP ≥cut-off) were included into multivariate logistic regression model. Independent predictors of death were aortic stenosis (OR 31.67; 95% CI 6.11-164.00) and NT proBNP ≥3.5 ng/ml (OR 5.75; 95%CI 1.69- 19.52).

Conclusion: In this group of pts hospitalized due to worsening of HF admission values of neither FABP nor other biomarkers studied were predictors of death during 1 year of follow up. FABP level after 2 weeks of hospital stay was related to occurrence of death but as predictor was inferior to NT-proBNP measured at the same time point.