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European Heart Journal Advance Access originally published online on November 24, 2006
European Heart Journal 2007 28(2):224-229; doi:10.1093/eurheartj/ehl405
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Heart-type fatty acid-binding protein permits early risk stratification of pulmonary embolism

Miriam Puls1, Claudia Dellas1,{dagger}, Mareike Lankeit1, Manfred Olschewski2, Lutz Binder3, Anette Geibel4, Christian Reiner1, Katrin Schäfer1, Gerd Hasenfuss1 and Stavros Konstantinides1,*

1 Department of Cardiology and Pulmonology, University of Goettingen, Germany
2 Department of Biostatistics, University of Freiburg, Germany
3 Department of Clinical Chemistry, University of Goettingen, Germany
4 Department of Cardiology and Angiology, University of Freiburg, Germany

Received 8 April 2006; revised 26 October 2006; accepted 7 November 2006; online publish-ahead-of-print 24 November 2006.

* Corresponding author. Tel: +49 551 39 12575; fax: +49 551 39 14131. E-mail address: skonstan{at}med.uni-goettingen.de

See page 146 for the editorial comment on this article (doi:10.1093/eurheartj/ehl433)

Aims We investigated the value of a novel early biomarker, heart-type fatty acid-binding protein (H-FABP), in risk stratification of patients with acute pulmonary embolism (PE).

Methods and results We prospectively included 107 consecutive patients with confirmed PE. The endpoints were (i) PE-related death or major complications and (ii) overall 30-day mortality. Overall, 29 patients (27%) had abnormal (>6 ng/mL) H-FABP levels at presentation. Of those, 12 (41%) had a complicated course, whereas all patients with normal baseline H-FABP had a favourable 30-day outcome (OR, 71.45; P < 0.0001). At multivariable analysis, H-FABP (P < 0.0001), but not cardiac troponin T (P = 0.13) or N-terminal pro-brain natriuretic peptide (P = 0.36), predicted an adverse outcome. Evaluation of a strategy combining biomarker testing with echocardiography revealed that patients with a negative H-FABP test had an excellent prognosis regardless of echocardiographic findings. In contrast, patients with a positive H-FABP test had a complication rate of 23.1% even in the presence of a normal echocardiogram, and this rose to 57.1% if echocardiography also demonstrated right ventricular dysfunction (OR vs. a negative H-FABP test, 5.6 and 81.4, respectively).

Conclusion H-FABP is a promising early indicator of right ventricular injury and dysfunction in acute PE. It may help optimize risk stratification algorithms and treatment strategies.

Key Words: Pulmonary embolism • Prognosis • Fatty acid-binding protein • Troponins • Natriuretic peptides


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