open access

Vol 72, No 6 (2014)
Original articles
Published online: 2014-02-10
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Early kinetics of heart-type fatty acid binding protein in patients undergoing dipyridamole stress echocardiography and relationship with high-sensitivity troponin

Giuseppe Lippi, Mariella Dipalo, Rosalia Aloe, Fiorenza Robuschi, Francesco Scioscioli, Livia Ruffini, Gianfranco Cervellin
DOI: 10.5603/KP.a2014.0043
·
Kardiol Pol 2014;72(6):527-533.

open access

Vol 72, No 6 (2014)
Original articles
Published online: 2014-02-10

Abstract

Background: The assessment of cardiospecific troponins is the main stay for diagnosing myocardial injury, although their diagnostic sensitivity remains suboptimal at patient admission to the emergency department (ED), thus paving the way for translational research to identify early and complementary biomarkers which may help improve the diagnostic sensitivity of high-sensitivity troponin immunoassays at patient presentation to the ED.

Aim: To investigate whether heart-type fatty acid binding protein (H-FABP) provides distinctive and/or adjunctive information over high-sensitivity troponin I (HS-TnI) in ED patients undergoing dipyridamole stress testing.

Methods: Thirty consecutive ED patients with chest pain but no myocardial ischaemia were challenged with dipyridamole-atropine and followed by echocardiography. Blood samples for assessing H-FABP and HS-TnI were collected before the dipyridamole challenge, immediately after, and 6 h afterwards.

Results: The concentration of HS-TnI in the whole cohort of patients did not vary significantly throughout the study period, whereas H-FABP significantly increased after the test (4.2 ng/mL, p = 0.003), but not 6 h afterwards (3.8 ng/mL, p = 0.372) compared to baseline (4.0 ng/mL). The kinetics was similar in patients with positive or negative results of stress testing. The frequency of biomarker increase after the test was greater for H-FABP than for HS-TnI immediately after the pharmacological challenge (77% vs. 53%), but was lower 6 h afterwards (30% vs. 63%). The number of patients with values exceeding the diagnostic threshold of both biomarkers remained constant throughout the study period.

Conclusions: These results suggest that dipyridamole stress echocardiography does not trigger substantial myocardial injury. We have also shown that release of H-FABP from stressed myocardium occurs without progression towards irreversible necrosis, and is more precious than that of TnI.

Abstract

Background: The assessment of cardiospecific troponins is the main stay for diagnosing myocardial injury, although their diagnostic sensitivity remains suboptimal at patient admission to the emergency department (ED), thus paving the way for translational research to identify early and complementary biomarkers which may help improve the diagnostic sensitivity of high-sensitivity troponin immunoassays at patient presentation to the ED.

Aim: To investigate whether heart-type fatty acid binding protein (H-FABP) provides distinctive and/or adjunctive information over high-sensitivity troponin I (HS-TnI) in ED patients undergoing dipyridamole stress testing.

Methods: Thirty consecutive ED patients with chest pain but no myocardial ischaemia were challenged with dipyridamole-atropine and followed by echocardiography. Blood samples for assessing H-FABP and HS-TnI were collected before the dipyridamole challenge, immediately after, and 6 h afterwards.

Results: The concentration of HS-TnI in the whole cohort of patients did not vary significantly throughout the study period, whereas H-FABP significantly increased after the test (4.2 ng/mL, p = 0.003), but not 6 h afterwards (3.8 ng/mL, p = 0.372) compared to baseline (4.0 ng/mL). The kinetics was similar in patients with positive or negative results of stress testing. The frequency of biomarker increase after the test was greater for H-FABP than for HS-TnI immediately after the pharmacological challenge (77% vs. 53%), but was lower 6 h afterwards (30% vs. 63%). The number of patients with values exceeding the diagnostic threshold of both biomarkers remained constant throughout the study period.

Conclusions: These results suggest that dipyridamole stress echocardiography does not trigger substantial myocardial injury. We have also shown that release of H-FABP from stressed myocardium occurs without progression towards irreversible necrosis, and is more precious than that of TnI.

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Keywords

stress testing, provocative testing, dipyridamole, troponin, heart type fatty acid binding protein (H-FABP)

About this article
Title

Early kinetics of heart-type fatty acid binding protein in patients undergoing dipyridamole stress echocardiography and relationship with high-sensitivity troponin

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 72, No 6 (2014)

Pages

527-533

Published online

2014-02-10

DOI

10.5603/KP.a2014.0043

Bibliographic record

Kardiol Pol 2014;72(6):527-533.

Keywords

stress testing
provocative testing
dipyridamole
troponin
heart type fatty acid binding protein (H-FABP)

Authors

Giuseppe Lippi
Mariella Dipalo
Rosalia Aloe
Fiorenza Robuschi
Francesco Scioscioli
Livia Ruffini
Gianfranco Cervellin

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