Akut ST Yüksekliği Olmayan Miyokard İnfarktüsü Tanısında Erken Diyagnostik Belirteç Olarak Kalp Tipi Yağ Asidi Bağlayıcı Protein’in Kalitatif Ölçümünün, Diğer Kardiyak Belirteçler İle Karșılaștırılması

Abstract

Objective: Heart type fatty acid binding protein (H-FABP) is a new cardiac marker which is used in early diagosis (within the first two hours) of acute myocardial infarction (MI) and which shows myocyte injury. In our study, it was aimed to compare bed-side H-FABP measurement with routinely used CK-MB and troponin I for early diagnosis of non ST elevation MI (NSTEMI) and for determining its exclusion capacity. Material and Method: A total of 48 patients who were admitted to emergency room with ischemic type chest pain lasting for more than 30 minute within the first 12 hours and who did not have ST segment elevation on electrocardigraphy (ECG) were included in the study. Definite diagnosis of NSTEMI was made in 24 patients as the result of 24-hour follow up, remaining 24 patients did not develop MI. Results: When various subgroups were analysed according to admission hours, H-FABP was detected to be a beter diagnostic marker (accuracy 85%) comparedto CK-MB and troponin with high sensitivity (79%) and specifity (93%) in early diagnosis (≤6 hours) (p<0,05). Conclusion: Bed-side H-FABP measurement may be considered to contribute to correct and early diagnosis as it elevated early following MI, its measurement is easy and it provides a rapid result.

Keywords

• Acute Coronary syndrome
• Non ST Elevation Myocardial Infarction
• H-FABP
• CK-MB
• troponin

Akut ST Yüksekliği Olmayan Miyokard İnfarktüsü Tanısında Erken Diyagnostik Belirteç Olarak Kalp Tipi Yağ Asidi Bağlayıcı Protein’in Kalitatif Ölçümünün, Diğer Kardiyak Belirteçler İle Karșılaștırılması

Abstract

Amaç: Kalp tipi serbest yağ asidi bağlayıcı protein (H-FABP), akut miyokardinfarktüsünün (MI) erken dönem (ilk iki saat) tanısında kullanılan ve miyosit hasarını gösteren yeni bir kardiyak belirteçdir. Çalıșmamızda yatak bașı kalitatif H-FABP ölçümünün, ST yükselmesiz MI (NSTEMI)’nü erken tanıma ve dıșlama kabiliyetini belirlemek için rutinde kullanılan CK-MB kütle ve troponin I ile karșılaștırılması amaçlanmıștır. Gereç ve yöntem: Çalıșmaya 30 dakikadan fazla süren iskemik tipte göğüs ağrısı yakınmasıyla ilk 12 saat içinde acil servise bașvuran ve elektrokardiyografi (EKG)’de ST yüksekliği bulunmayan 48 hasta alınmıștır. 24 saatlik takip sonucunda bu hastaların 24’ünde NSTEMI tanısı kesinleșmiș, kalan 24 hastada ise MI gelișmemiștir. Bulgular: Hastaneye bașvuru saatlerine göre değișik altgruplar incelendiğinde H-FABP’nin erken tanıda (≤6 saat) yüksek sensitivite (%79) ve spesifisite (%93) ile CK-MB ve troponine kıyasla daha iyi bir diyagnostik belirteç olduğu (geçerlilik indeksi %85) tesbit edilmiștir (p<0,05). Sonuç: H-FABP’ininfarkt sonrası erken yükselmesi, ölçümünün kolay olması ve hızlı sonuç vermesi gibi nedenlerle acil servislerde yatak bașı kullanımının doğru ve erken tanıda katkı sağlayacağı düșünülebilir..

Keywords

• Akut Koroner Sendrom
• ST YükselmesizMiyokardİnfaktüsü
• H-FABP
• CK-MB
• Troponin

References

1. 1. Antman EM, Braunwald E. Acute myocardial infarction In: Braunwald E, Zipes D, Libby P, eds. Heart Disease. Ed: A textbook of cardiovascular medicine. Philadelphia: WB Saunders company 2001:1131-1135.
2. 2. Newby LK, Gibler B, Chriztenson RH. Serum markers for diagnosis and risk stratification in acute coronary syndromes, ed; Cannon CP, Humana Pres, NJ, 1999:147- 171.
3. 3. Hodgson L. Cost containment in the emergency department. CAL/ACEP source guide 1998; 710: 23.
4. 4. Hargarten K, Chapman PD, Stueven HA, et al. Prehospital prophylactic lidocaine does not favorably affect outcome in patients with chest pain. Ann Emerg Med 1990; 19: 1274- 1279.
5. 5. Reeder G. Contemporary diagnosis and management of unstable angina. Mayo Clinic Proceedings 2000; 75: 953-960.
6. 6. Rusnack RA, Stair TO, Hansen K, et al. Litigation against the emergency physician: Common features in cases of missed myocardial infarction. Ann Emerg Med 1989; 18: 1029-1034.
7. 7. Anon, Joint European Society of Cardiology / American College of Cardiology Committee. Myocardial infarction redefined: a consensus document of the Joint European Society of Cardiology / American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J 2000; 21: 1502-1513.
8. 8. Schaap FG, Binas B, Danneberg H, et al. Impaired long-chain fatty acid utilization by cardiac myocytes isolated from mice lacking the hearttype fatty acid binding protein gene. Circ Res 1999; 85: 329-337.

9. 9. Glatz JFC, van der Vusse GJ, Simoons ML et al. Fatty acid binding protein and the early detection of acute myocardial infarction. Clin Chim Acta 1998; 272: 87-92.
10. 10. Van Nieuwenhoven FA, Kleine AH, Wodzig WH, et al. Discrimination between myocardial and skeletal muscle injury by assesment of the plasma ratio of myoglobin over fatty acid binding protein. Circulation 1995; 92: 2848-2854.
11. 11. Yoshimoto K, Tanaka T, Somiya K, et al. Human heart-type cytoplasmic fatty acid-binding protein as an indicator of acute myocardial infarction. Heart Vessels 1995;10: 304-309.
12. 12. Tanaka T, Hirota Y, Sohmiya K, et al. Serum and urinary human heart fatty acid-binding pro¬tein in acute myocardial infarction. Clin Biochem 199; 24:195-201.
13. 13. Chan C, Sum KW, Cheeung KY, et al. Development of a quantitative lateralflow assay for rapid detection of fatty acid-binding protein. Journal of Immunological Methods 2003; 279: 91- 100.
14. 14. Nakata T, Hashimoto A, Hase M, et al. Human Heart-Type fatty acidbinding protein as an early diagnostic and prognostic marker in acute coronary syndrome. Cardiology 2003; 99: 96-104.
15. 15. Chan C, Wan T, Watkins K, et al. Rapid analysis of fatty acid-binding üproteins with immunosensors and immunotests for early monitoring of tissue injury. Biosensors and Bioelectronics 2005;20: 2566-2580.
16. 16. Zeren G, Erer HB, Kırıs T, et al. ST segment yükselmesiz akut koroner sendromlu hastalarda kalp tipi yağ asidi bağlayıcı proteinin koroner arter hastalığının yaygınlık ve ciddiyeti ile ilişkisi. Arch Turk Soc Cardiol 2013;41: 610-616
17. 17. Freund Y, Chenevier-Gobeaux C, Leumani F, et al. Heart-type fatty acid binding protein and the diagnosis of acute coronary syndrome in the ED. Am Journal of Emergency Medicine 2012; 30:1378– 1384.
18. 18. Glatz JF, Vusse GJ, Simoons M, et al. Fatty acid-binding protein and early detection of myocardial infarction. Clinica Chimica Acta 1998; 272: 87- 92.
19. 19. Haastrup B, Gill S, Kristensen R, et al. Biochemical markers of ischaemia for the early identification of acute myocardial infarction without ST segment elevation. Cardiology 2000; 84: 254-261.
20. 20. Yoshihiko S, Tomita Y, Tekano Te, et al. Office cardiologists cooperative study on whole blood rapid panel tests in patients with suspicious acute myocardial infarction. Circ J 2004; 68: 144-148.
21. 21. Ruzgar O, Bilge AK, Bugra Z et al. The use of human heart-type fatty acidbinding protein as an early diagnostic biochemical marker of myocardial necrosis in patients with acute coro nary syndrome, and its comparison with troponin-T and creatine kinase myocardial band. Heart and Vessels 2006;21: 309–314