How to Cite
Abstract
PROGNOSIS OF ADVERSE OUTCOMES AFTER MYOCARDIAL INFARCTION BASED ON LEVEL OF HEART FATTY ACID BINDING PROTEIN
Kopytsya M.P., Petyunina O.V., Tytarenko N.V., Hileva Y.V., Vishnevskaya I.R., Peteneva L.L., Oparin O.L.
National Institute of Therapy n.a. L.T. Malaya of NAMS of Ukraine, Ukraine
Abstract.
Heart-type Fatty Acid Binding Protein (H-FABP) is a cytoplasmic protein. It`s released 30 minutes after onset of ischemia and enhances transportation of fatty acids from cardiomyocytes.
Aim: to examine the prognostic value of biochemical and clinical markers and their sum in relation to the development of adverse outcomes in six months follow up after acute myocardial infarction (AMI).
Methods and results. 189 patients with AMI were examined. They were divided into two groups: 1 - NSTEMI n=36 (9%); 2 - STEMI n=153 (81%), male 138 (73%). H-FABP was determined in blood plasma with ELISA, level of H-FABP was measured using normal value up to 1 ng/ml. During a 6-month follow-up 17 patients (9%) died. About 60 clinical and biochemical markers were analyzed using sequential Wald-Genkin's procedure. The curves of sensitivity and specificity were made using method of ROC-analysis and the threshold values were chosen for each parameter. H-FABP had sufficient level of sensitivity 85.7%, but insufficient specificity (49,2%), and such markers as age, heart failure class (Killip) and glucose level had insufficient sensitivity (50,0%; 66,7%; 43,7%) according to prognosis of death case. Each parameter was estimated in scores in relation to the cut-off value and the scale for measurement of prognostic coefficient (PC) using Gubler's method was proposed. Positive value of PC is associated with adverse outcomes in patients with AMI.
Conclusions: The mathematical model including the sum of markers – H-FABP level, age, glucose level, heart failure class (Killip) allows to prognose adverse outcomes after AMI with sensitivity 88% and specificity 78%.
Key words:
H-FABP, acute myocardial infarction, prognosis
Прогноз для розвитку несприятливих подій після перенесеного інфаркту міокарда на підставі рівня серцевого білку зв'язуючого жирні кислоти
Копиця М.П., Петюніна О.В., Титаренко Н.В., Гільова Я.В., Вишневська І.Р., Петеньова Л.Л., Опарін О.Л.
ДУ “Національний інститут терапії ім.Л.Т.Малої НАМН України”
Резюме.
Серцевий білок, що зв'язує жирні кислоти (СБСЖК) - цитоплазматический протеїн, який вивільняється протягом 30 хвилин після виникнення ішемії і підсилює транспорт жирних кислот з кардіоміоцитів.
Мета: прогнозування летального результату після перенесеного гострого інфаркту міокарда (ГІМ) на підставі аналізу біохімічних і клінічних маркерів і їх суми.
Матеріали і методи. Обстежено 189 пацієнтів з гострим інфарктом міокарду. Хворих з ГКС поділили на 2 групи: 1- інфаркт міокарду без зубця Q (n=36); 2 - інфаркт міокарда с зубцем Q (n=153), чоловіки 138 (73%). Визначали білок, зв’язуючий вільні жирні кислоти (БЗВЖК) в сироватці крови імуноферментним методом, нормальними значеннями рахували його концентрацію до 1 нг/мл. Протягом 6 місяців періоду спостереження 17 паціентів (9%) померли. Були побудовані криві чутливості та специфічності методом ROC аналізу та обрані порогові значення для кожного параметру. Виявлено, що БЗВЖК мав достатній рівень чутливості 85,7%, але недостатню специфічність (49,2%), а показники - вік, клас серцевої недостатності за Killip та рівень глюкози мають недостатню чутливість (50,0%; 66,7%; 43,7%) відповідно для прогнозу летального результату. Бальна оцінка була проведена для кожного параметру відносно порогового значення та запропонована шкала для розрахунку прогностичного коефіцієнту (ПК) за методом Гублера. Позитивне значення ПК асоціюється з летальнім результатом у хворих на ГІМ.
Висновок: математична модель з урахуванням суми ознак - рівня БЗВЖК, віку, рівня глюкози, серцевої недостатності за класифікацією Killip дозволяє прогнозувати летальний результат у хворих на ГІМ з чутливістю 88,2% і специфічністю 77,9%
Ключові слова:
БЗВЖК, гострий інфаркт міокарда, прогноз
Прогноз для развития неблагоприятных событий после перенесенного инфаркта миокарда на основании уровня сердечного белка связывающего жирные кислоты
Копица Н.П., Петюнина О.В., Титаренко Н.В., Гилева Я.В., Вишневская И.Р., Петенеова Л.Л., Опарин А.Л.
ГУ "Национальный институт терапии им.Л.Т.Малои НАМН Украины"
Резюме.
Сердечный белок, связывающий жирные кислоты (СБСЖК) - цитоплазматический протеин, который высвобождается в течение 30 минут после возникновения ишемии и усиливает транспорт жирных кислот из кардиомиоцитов.
Цель: прогнозирование летального исхода после перенесенного острого инфаркта миокарда (ОИМ) на основании анализа биохимических и клинических маркеров и их суммы.
Материалы и методы. Обследовано 189 пациентов с острым инфарктом миокарда. Больных с ОКС разделили на 2 группы: 1 - инфаркт миокарда без зубца Q (n = 36); 2 - инфаркт миокарда с зубцом Q (n = 153), мужчины 138 (73%). Определяли белок, связывающий свободные жирные кислоты (БССЖК) в сыворотке крови иммуноферментным методом, нормальными значениями считали его концентрацию до 1 нг / мл. В течение 6 месяцев периода наблюдения 17 пациентов (9%) умерли. Были построены кривые чувствительности и специфичности методом ROC анализа и выбраны пороговые значения для каждого параметра. Выявлено, что БССЖК имел достаточный уровень чувствительности 85,7%, но недостаточную специфичность (49,2%), а показатели - возраст, класс сердечной недостаточности по Killip и уровень глюкозы имеют недостаточную чувствительность (50,0%; 66,7%; 43,7%) соответственно для прогноза летального исхода. Балльная оценка была проведена для каждого параметра относительно порогового значения и предложена шкала для расчета прогностического коэффициента (ПК) по методу Гублера. Положительное значение ПК ассоциируется с летальным исходом у больных ОИМ.
Вывод: математическая модель с учетом суммы признаков - уровня БССЖК, возраста, уровня глюкозы, сердечной недостаточности по классификации Killip позволяет прогнозировать летальный исход у больных ОИМ с чувствительностью 88,2% и специфичностью 77,9%
Ключевые слова:
БССЖК, острый инфаркт миокарда, прогноз
References
Body R., Carley S., McDowell G. et al. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay // J Am Coll Cardiol. -2011. –Vol.58, Suppl.13. –P.1332-1339.
Body R., Dixon D., Burrows G. et al. Economic evaluation of a heart fatty acid binding protein based protocol for rapid chest pain assessment // 14th International Conference on Emergency Medicine. Acad Emerg Med. -2012. –Vol.19, Suppl.6. –P.746-747.
Body R., McDowell G., Carley S., et al. A FABP-ulous ‘rule out’ strategy? Heart fatty acid binding protein and troponin for rapid exclusion of acute myocardial infarction //Resuscitation. -2011. –Vol.82, Suppl.8. –P.1041-1046
Carless D.R., Wnęk M., Knox C. et al. Clinical and analytical evaluation of an immunoturbidimetric heart-type fatty acid-binding protein assay // Scand J Clin Lab Invest. -2013. –Vol.73, Suppl.1. –P.48-53.
Carroll С., Al Khalaf М, Stevens J.W., et al. Heart-type Fatty Acid Binding Protein as an Early Marker for Myocardial Infarction. Systematic Review and Meta-Analysis // Emerg Med J. -2013. -Vol.30, Suppl.4. -P.280-286.
Collinson P.O., Premachandram S., Hashemi K. Prospective audit of incidence of prognostically important myocardial damage in patients discharged from emergency department. // BMJ. -2000. –Vol.320, Suppl.7251. –P,1702-1705.
Daly M.J., McCann C.J., Owens C.G. et al. Heart fatty acid-binding protein in combination with the 80-lead body surface potential map improves early detection of acute myocardial infarction in patients who are cardiac troponin T-negative at presentation // J Electrocardiol. -2011 –Vol.44, Suppl.4. –P.432-438.
Dellas C., Puls M., Lankeit M., et al. Elevated heart-type fatty acid-binding protein levels on admission predict an adverse outcome in normotensivepatients with acute pulmonary embolism // J Am Coll Cardiol. -2010. –Vol.55, Suppl.19. –P.2150-2157.
Ekelund U., Forberg J.L. New methods for improved evaluation of patients with suspected acute coronary syndrome in the emergencydepartment // Emerg Med J. -2007 –Vol.24. Suppl.12. –P.811-814.
Goodacre S., Cross E., Arnold J. et al. The health care burden of acute chest pain // Heart. -2005. –Vol.91. –P.229-230
Hamm C.W. et al ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC) // Eur. Heart J. -2011. –Vol.32, Suppl.23. –P.2999-3054.
Hammarsten O., Fu M.L., Sigurjonsdottir R., et al. Troponin T percentiles from a random population sample, emergency room patients and patients with myocardialinfarction // Clin Chem. -2012. –Vol.58, Suppl.3. –P.:628-637.
Hollander J.E. Highly sensitive troponins the answer or just more questions? // J Am Coll Cardiol. -2009. –Vol.54, Suppl.13. –P.1173-1175.
Inoue K., Suwa S., Ohta H., et al. Heart fatty acid-binding protein offers similar diagnostic performance to high-sensitivity troponin T in emergencyroom patients presenting with chest pain // Circ J. -2011. -Vol.75, Suppl.12. –P.2813-2820.
Kilcullen N., Morrell C., Thistlethwaite S.J. et al. Heart-type fatty acid-binding protein predicts long-term mortality and re-infarction in consecutive patients withsuspected acute coronary syndrome who are troponin-negative. // J Am Coll Cardiol. -2010. –Vol.55, Suppl.23. –P.2590-2598.
Kilcullen N., Viswanathan K., Das R. et al. Heart-type fatty acid-binding protein predicts long-term mortality after acute coronary syndrome and identifies high-risk patients across the range of troponin values // J. Am. Coll. Cardiol. -2007. –Vol.50, Suppl.21. –P.2061-2067.
McCann C.J., Glover B.M., Menown I.B., et al. Novel biomarkers in early diagnosis of acute myocardial infarction compared with cardiac troponin T //Eur Heart J. -2008. –Vol. 29, Suppl.23. –P.2843-2850.
McMahon C.G., Lamont J.V., Curtin E., et al. Diagnostic accuracy of heart-type fatty acid-binding protein for the early diagnosis of acute myocardial infarction // Am J Emerg Med. -2012. –Vol.30< Suppl.2. –P.267-274.
Muehlschlegel J.D., Perry T.E., Liu K.Y., et al. Heart-type fatty acid binding protein is an independent predictor of death and ventricular dysfunction after coronary artery bypass graft surgery // Anesth Analg. -2010. –Vol.111, Suppl.. –P.1101-1109.
O’Donoghue M., de Lemos J.A., Morrow D.A., et al. Prognostic utility of Heart-type fatty acid-binding protein in patients with acute coronary syndromes // Circulation. -2006. –Vol.114, Suppl.6. –P.550-557.
Oezkur M., Gorski A., Peltz J. Preoperative serum h-FABP concentration is associated with postoperative incidence of acute kidney injury in patients undergoing cardiac surgery // BMC Cardiovascular Disorders. -2014. -Vol.14. -P.117.
Pearson I.R., Hall A.S., Gale C.P. еt al. In Acute Coronary Syndromes, Heart-type Fatty Acid Binding Protein is a More Accurate Predictor of Long Term Prognosis than Troponin // Circulation. -2010; -Vol.122:A11374
Pope J.H., Aufderheide T.P., Ruthazer R., et al. Missed diagnoses of acute cardiac ischemia in the emergency department. // N Engl J Med. -2000. –Vol.342, Suppl.16. –P.1163-1170.
Puls M., Dellas C., Lankeit M., et al. Heart-type fatty acid-binding protein permits early risk stratification of pulmonary embolism // Eur Heart J. -2007. –Vol.28, Suppl.2. –P.224-229.
Reichlin T., Hochholzer W., Bassetti S. et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays // N Engl J Med. -2009. –Vol.361, Suppl.9. –P.858-867
Thygesen K. et al. Third universal definition of myocardial infarction // Eur Heart J. -2012. –Vol.33, Suppl.20. –P.2551-2567.
Viswanathan K., Alistar S.H., Barth J.H. An Evidence-Based Approach to the Assessment of Heart-Type Fatty Acid Binding Protein in Acute Coronary Syndrome // Clin.Biochem.Rev. -2012 -Vol. 33, Syppl.1. -P.3–11.
"Inter Collegas" is an open access journal: all articles are published in open access without an embargo period, under the terms of the CC BY-NC-SA (Creative Commons Attribution ‒ Noncommercial ‒ Share Alike) license; the content is available to all readers without registration from the moment of its publication. Electronic copies of the archive of journals are placed in the repositories of the KhNMU and V.I. Vernadsky National Library of Ukraine.
Copyright Agreement
1. This Agreement on the transfer of rights to use the work from the Co-authors to the publisher (hereinafter the Agreement) is concluded between all the Co-authors of the work, represented by the Corresponding Author, and Kharkiv National Medical University (hereinafter the University), represented by an authorized representative of the Editorial Board of scientific journals (hereinafter the Editorial Board).
2. This Agreement is an accession agreement within the meaning of clause 1 of Article 634 of the Civil Code of Ukraine: that is, a contract, "the terms of which are established by one of the parties in forms or other standard forms, which can be concluded only by joining the other party to the proposed contract as a whole. The other party cannot offer its terms of the contract." The party that established the terms of this contract is the University.
3. If there is more than one author, the authors choose the Corresponding Author, who communicates with the Editorial Board on his own behalf and on behalf of all Co-authors regarding the publication of a written work of a scientific nature (article or review, hereinafter referred to as the Work).
4. The contract begins from the moment of submission of the manuscript of the Work by the Corresponding Author to the Editorial Board, which confirms the following:
4.1. all Co-authors of the Work are familiar with and agree with its content, at all stages of reviewing and editing the manuscript and the existence of the published Work;
4.2. all Co-authors of the Work are familiar with and agree to the terms of this Agreement.
5. The published Work is in electronic form in public access on the websites of the University and any websites and electronic databases in which the Work is posted by the University and is available to readers under the terms of the "Creative Commons" license (Attribution NonCommercial Sharealike 4.0 International)" or more free licenses "Creative Commons 4.0".
6. The Corresponding Author transfers, and the University receives, the non-exclusive property right to use the Work by placing the latter on the University's websites for the entire term of copyright. The University participates in the creation of the final version of the Work by reviewing and editing the manuscript of the article or review provided to the Editorial Board by the Corresponding Author, translating the Work into any languages. For the participation of the University in the finalization of the Work, the Co-authors agree to pay the invoice issued to them by the University, if such payment is provided by the University. The size and procedure of such payment are not the subject of this contract.
7. The University has the right to reproduce the Work or its parts in electronic and printed forms, to make copies, permanent archival storage of the Work, distribution of the Work on the Internet, repositories, scientometric databases, commercial networks, including for monetary compensation from third parties.
8. The co-authors guarantee that the manuscript of the Work does not use works whose copyright belongs to third parties.
9. The authors of the Work guarantee that at the time of submission of the manuscript of the Work to the Editorial Board, the property rights to the Work belong only to them, neither in whole nor in part have they been transferred to anyone (not alienated), they are not the subject of a lien, litigation or claims by third parties.
10. The Work may not be posted on the University's website if it violates a person's right to the privacy of his personal and family life, harms public order and health.
11. The work may be withdrawn by the Editorial Board from the University websites, libraries and electronic databases where it was placed by the Editorial Board, in cases of detection of violations of the ethics of the authors and researchers, without any compensation for the losses of the Co-authors. At the time of submission of the manuscript to the Editorial Board and all stages of its editing and review, the manuscript must not have already been published or submitted to other editorial offices.
12. The right transferred under this Agreement extends to the territory of Ukraine and foreign countries.
13. The rights of Co-authors include the requirement to indicate their names on all copies of the Work or during any public use or public mention of the Work; the requirement to preserve the integrity of the Work; legal opposition to any distortion or other encroachment on the Work, which may harm the honor and reputation of the Co-authors.
14. Co-authors have the right to control their personal non-property rights by familiarizing themselves with the text (content) and form of the Work before its publication on the University's website, when transferring it to a printing company for reproduction or when using the Work in other ways.
15. The Co-authors, in addition to the property rights not transferred under this Agreement and taking into account the non-exclusive nature of the rights transferred under this Agreement, retain the property rights to finalize the Work and to use certain parts of the Work in other works created by the Co-authors.
16. The Co-authors are obliged to notify the Editorial Board of all errors in the Work, discovered by them independently after the publication of the Work, and to take all measures to eliminate such errors as soon as possible.
17. The University undertakes to indicate the names of the Co-authors on all copies of the Work during any public use of the Work. The list of Co-authors may be shortened according to the rules for the formation of bibliographic descriptions determined by the University or third parties.
18. The University undertakes not to violate the integrity of the Work, to agree with the Corresponding Author on all changes made to the Work during processing and editing.
19. In case of violation of their obligations under this Agreement, its parties bear the responsibility defined by this Agreement and the current legislation of Ukraine. All disputes under the Agreement are resolved through negotiations, and if the negotiations do not resolve the dispute – in the courts of the city of Kharkiv.
20. The parties are not responsible for the violation of their obligations under this Agreement, if it occurred through no fault of theirs. The party is considered innocent if it proves that it has taken all measures dependent on it for the proper fulfillment of the obligation.
21. The Co-authors are responsible for the truthfulness of the facts, quotes, references to legislative and regulatory acts, other official documentation, the scientific validity of the Work, all types of responsibility to third parties who have claimed their rights to the Work. The co-authors reimburse the University for all costs caused by claims of third parties for infringement of copyright and other rights to the Work, as well as additional material costs related to the elimination of identified defects.