What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic heart failure (n=113). Intervention: Persistently high serum H-FABP levels vs. Normal or decreased H-FABP levels. Primary outcome: Cardiac events (cardiac death or worsening CHF requiring readmission) (HR 5.68, p=0.012).

December 25, 2007Circulation Journal66 citationsOpen Access

Persistently Increased Serum Concentration of Heart-Type Fatty Acid-Binding Protein Predicts Adverse Clinical Outcomes in Patients With Chronic Heart Failure

TNTakeshi Niizeki YTYasuchika Takeishi TATakanori Arimoto

Key Result

Persistently high serum H-FABP levels at admission and discharge in patients with chronic heart failure were associated with a significantly increased risk of cardiac events (HR 5.68).

Study Design

Type

Cohort (n=113)

Multicenter

Structured PICO

Does persistently high serum H-FABP predict adverse clinical outcomes in patients with chronic heart failure?

Population

113 patients hospitalized for chronic heart failure, followed for a mean of 624 days to assess the prognostic value of serial H-FABP measurements.

Exposure

Serial measurement of serum H-FABP levels at admission and discharge, specifically identifying patients with persistently high H-FABP levels (≥4.3 ng/ml at both time points).

Comparator

Patients with persistently normal H-FABP levels (<4.3 ng/ml) or levels that decreased to normal at discharge.

Outcome

Composite of cardiac death (death from worsening CHF or sudden cardiac death) and worsening CHF requiring readmission.composite

Persistently elevated serum H-FABP levels at discharge in patients with chronic heart failure independently predict a higher risk of cardiac death and readmission.

Main Result

Hazard Ratio: 5.68

Absolute Event Rate: 50.9% vs 9.8%

p-value: p=0.012

Limitations

Did not ascertain the association between deterioration in cardiac function and the mechanism of ongoing myocardial damage
Could not identify the factors involved in the progression from stable CHF to recurrent decompensation
Did not ascertain the association between deterioration in cardiac function and the mechanism of ongoing myocardial damage.
Could not identify the factors involved in the progression from stable CHF to recurrent decompensation in patients with high serum H-FABP levels.

Abstract

BACKGROUND: Heart-type fatty acid-binding protein (H-FABP) is a small cytosolic protein that is released into the circulation when the myocardium is injured. This study examined whether serial measurement of the H-FABP level provides additional prognostic information. METHODS AND RESULTS: Serum H-FABP levels were measured in 113 consecutive chronic heart failure (CHF) patients at both admission and discharge. The following 3 patterns of changes were identified. In 41 patients, H-FABP levels ( or =4.3 ng/ml) at admission, and in 21 of them (29%), H-FABP decreased to the normal range at discharge (Group 2), whereas 51 had persistently high H-FABP levels despite improvement in symptoms and signs of CHF (Group 3). There were 33 cardiac events (29%) during the follow-up period, and Group 3 had significantly higher cardiac event rates than Groups 1 and 2 (p=0.0002). Group 3 had the highest cardiac risk among the groups (hazard ratio 5.68, p=0.012). CONCLUSION: Serial measurement of the H-FABP level is a new monitoring tool that provides information to guide optimal therapy and management of CHF patients.

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