Giá trị tiên lượng của h FABP trong nhồi máu cơ tim cấp

PROGNOSTIC VALUE OF H-FABP, A NEW MARKER IN ACUTE MYOCARDIAL INFARCTION Dr GIAO THI THOA- Đa Nang Hopital A/ Prof NGUYEN LAN HIEU- Ha Noi Medical University Prof HUYNH VAN MINH- Hue University of Medicine and Pharmacy Deaths from Cardiovascular disease have been declining in developed nations but have increased in low- and middle-income countries Over 80% of the world's CVD deaths now occur in developing nations Currently, heart disease is the biggest health threat to humans Among them, AMI is one of the leading causes of death and disability Non ACS diagnosis? Stable Angina? Unstable Angina? NSTEMI? Despite the development of cardiac centers and theories of high sensitivity and specificity of biomarkers in myocardial necrosis The evaluation of unexplained chest pain symptoms remains a huge challenge ACS Biomarker Development In order to improve the accuracy and effectiveness of diagnosis of MI, clinical researchers have discovered a new type of cardiac enzyme called H-FABP (Heart-type Fatty Acid Binding Protein) Moriates C, Maisel A.( 2010), “The utility of biomarkers in sorting out the complex patient”, Am J Med, 123(5), pp.393-9 Displays an array of biomarkers of different stages of cardiac disease H-FABP was first shown to be released from injured myocardium in 1988, after which its application as a biochemical marker has been investigated H-FABP is the quickest marker for diagnosis of MI in the early stage when ECG is unclear • H-FABP is a small, cytoplasmic protein • Molecular weight of only 15 kDa • 20 times more cardiac specific than Myoglobin H-FABP has demonstrated its outstanding capabilities of sensitivity and specificity, superior to troponin, particularly in the earliest stages of 0-6 hours Within only 30 minutes after onset of AMI, H-FABP became detectable in blood and increased very quickly Baseline Characteristics Risk factors Frequency (n =62) Percent (%) X ± SD Dyslipidemia 32 51.6 70.23±134.8 Hypertension 36 58.1 101.25±142.5 Diabetes 12 19.4 97.37±95.9 Obesity 12 19.4 105.74±117.5 Smoking 34 54.8 124.92±244.3 The number of patients with hypertension was the highest at 58.1%, followed by patients with smoking at 54.8% However, the average levels of H-FABP in the smoking group was higher than the hypertension group Levels of CK, CK MB, Troponin T, myoglobin, NT pro BNP, H-FABP measured for the first time Onset of AMI Level CK CK-MB Troponin T * NT-proBNP* Myoglobin H-FABP * 1-6h (n = 27) 7-12h (n = 9) 13-24h (n = 26) 232 ± 41,7 41,26±7,2 0,74±0,6 1956,89±653,5 35,30±147,7 157,75±55,64 1409,50±697,9 135,34±57,6 1,03±0,4 1861,42±1200,6 1604,25±227,5 384,82±98,4 2805±775,78 210±48,5 18,12±14,2 4975,79±1942,7 506,83±164,9 93,11±25,3 The level of biomarkers such as Troponin, NT-proBNP, and H-FABP changed over time and was accepted as statistically significant Levels of CK, CK MB, Troponin T, myoglobin, NT pro BNP, H-FABP measured for the second time Onset of AMI Levels CK CK-MB Troponin T NT-proBNP Myoglobin H-FABP 25-36h (n=40) >36h (n=22) 2544,9±562,4 229,43±53,0 6,23±1,2 5324,80±3358,1 1010,83±554,5 13,93±4,8 4788,86± 2951,8 138,78±56,2 5,43±1,7 2119,48±761,8 373,15±174,1 4,75±0,9 The levels of biomarkers such as Troponin, NT-proBNP, and H-FABP changed over time, especially the level of H-FABP decreased at 25-36 hours Variation of H-FABP level in patients with AMI H-FABP became detectable very soon in serum (less than one hour) and increased rapidly in most cases The median levels of H-FABP peaked at 7-12 hours and returned to normal after 36 hours Relationship between H-FABP level and Killip class Level Class Class I n % H-FABP (X ± SD) 30 48,4 51,46±15,7 Class II 18 29,0 136,70±43,9 Class III 6,5 138,10±30,4 Class IV 10 16,1 818,65±422,2 Total 62 100,0 p < 0,05 The patients with Killip class I was the highest at 48.4% The correlation between the level of H-FABP and Killip class in patients with MI was accepted statistically significant Correlation of H-FABP and early complications in patients with myocardial infarction Complications Arrhythmias * Heart failure* Cardiogenic shock Sudden death* Recurrent MI Acute mechanical complications n 15 24 14 11 % 24,2 38,7 22,6 17,7 4,8 3,2 H-FABP (X ± SD) 161,09±31,3 143,11±25,4 175,63±39,4 180,77±68,4 84,61±25,6 79,95±53,6 The patient with heart failure group was the highest at 38.7% The average level of H-FABP in the group with sudden death was the highest Correlation of H-FABP and early complications in patients with myocardial infarction Complications Arrhythmias * Heart failure* Cardiogenic shock Sudden death* Recurrent MI Acute mechanical complications n 15 24 14 11 % 24,2 38,7 22,6 17,7 4,8 3,2 H-FABP (X ± SD) 161,09±31,3 143,11±25,4 175,63±39,4 180,77±68,4 84,61±25,6 79,95±53,6 There was a correlation between the level of H-FABP and complications such as arrhythmias, heart failure, sudden death and this finding was accepted as statistically significant Correlation of H-FABP and the number of complications in one patient No of complications Total Frequency (n =62) 24 12 10 8 62 Ratio % 38,7 19,4 16,1 12,9 12,9 100,0 H-FABP (X ± SD) 28,78±45,3 112,48±74,3 147,29±201,9 173,74±120,1 238,06±382,5 The percentage of patients without complications accounted for 38.7% and the average level of H-FABP in this group was also the lowest The percentage of patients having four complications accounted for 12.9% and the average level of H-FABP in this group was the highest Correlation of the level of H-FABP between fatal and non-fatal groups Concentration Mortality (n=12) Non-mortality (n=50) p H-FABP 180,77±68,4 103,91±29,69 [...]... patients with hypertension was the highest at 58.1%, followed by patients with smoking at 54.8% However, the average levels of H- FABP in the smoking group was higher than the hypertension group Levels of CK, CK MB, Troponin T, myoglobin, NT pro BNP, H- FABP measured for the first time Onset of AMI Level CK CK-MB Troponin T * NT-proBNP* Myoglobin H- FABP * 1- 6h (n = 27) 7-1 2h (n = 9) 13-2 4h (n = 26) 232... The levels of biomarkers such as Troponin, NT-proBNP, and H- FABP changed over time, especially the level of H- FABP decreased at 25-36 hours Variation of H- FABP level in patients with AMI H- FABP became detectable very soon in serum (less than one hour) and increased rapidly in most cases The median levels of H- FABP peaked at 7-12 hours and returned to normal after 36 hours Relationship between H- FABP. .. Complications Arrhythmias * Heart failure* Cardiogenic shock Sudden death* Recurrent MI Acute mechanical complications n 15 24 14 11 3 2 % 24,2 38,7 22,6 17,7 4,8 3,2 H- FABP (X ± SD) 161,09±31,3 143,11±25,4 175,63±39,4 180,77±68,4 84,61±25,6 79,95±53,6 The patient with heart failure group was the highest at 38.7% The average level of H- FABP in the group with sudden death was the highest Correlation of H- FABP. .. level of H- FABP in this group was also the lowest The percentage of patients having four complications accounted for 12.9% and the average level of H- FABP in this group was the highest Correlation of the level of H- FABP between fatal and non-fatal groups Concentration Mortality (n=12) Non-mortality (n=50) p H- FABP 180,77±68,4 103,91±29,69