CARDIOVASCULAR MEDICINE

Heart-type fatty acid binding protein is a novel prognostic marker in patients with non-ischaemic dilated cardiomyopathy

K Komamura¹, T Sasaki³, A Hanatani², J Kim², K Hashimura², Y Ishida², Y Ohkaru⁴, K Asayama⁴, T Tanaka⁵, A Ogai⁶, T Nakatani⁷, S Kitamura⁷, K Kangawa⁸, K Miyatake², M Kitakaze²

¹ Department of Cardiovascular Dynamics, National Cardiovascular Centre Research Institute, Suita, Japan
² Division of Cardiology, National Cardiovascular Centre, Suita, Japan
³ Division of Cardiology, Osaka Koseinenkin Hospital, Osaka, Japan
⁴ Division of Laboratory Products, Dainippon Sumitomo Pharma Co, Ltd, Osaka, Japan
⁵ Department of Pharmaceutical Life Sciences, Osaka University of Pharmaceutical Sciences, Takatsuki, Japan
⁶ Department of Epidemiology, National Cardiovascular Centre Research Institute, Suita, Japan
⁷ Department of Cardiovascular Surgery, National Cardiovascular Centre, Suita, Japan
⁸ Department of Biochemistry, National Cardiovascular Centre Research Institute, Suita, Japan

Correspondence to:
Dr Kazuo Komamura
National Cardiovascular Centre Research Institute, 5-7-1 Fujishirodai, Suita 565-8565, Japan; kkoma{at}hsp.ncvc.go.jp

Objective: To determine whether concentrations of heart-type fatty acid binding protein (H-FABP) measured before hospital discharge predict critical cardiac events in patients with idiopathic dilated cardiomyopathy (DCM).

Patients: 92 consecutive patients with DCM were enrolled and followed up for four years.

Main outcome measures: Serum concentrations of H-FABP, brain natriuretic peptide (BNP), cardiac troponin T before hospital discharge and survival rate.

Results: 23 patients died of cardiac causes, received a left ventricular assist device or underwent heart transplantation during the four-year follow up. Univariate analyses showed that New York Heart Association functional class, heart rate, ejection fraction, serum H-FABP and plasma BNP were significant variables. According to multivariate analysis, serum H-FABP and plasma BNP concentrations were independent predictors of critical cardiac events. Cardiac troponin T before hospital discharge was not a predictor. The area under the receiver operating characteristic curve for death from critical cardiac events was similar between H-FABP and BNP. Patients with an H-FABP concentration at or above the median ( 5.4 ng/ml) had a significantly lower survival rate than those below the median, according to analysis by log rank test (p < 0.0001). When combined with BNP concentration at or above the median ( 138 pg/ml), H-FABP below the median predicted the worst prognosis among the combinations.

Conclusions: The concentration of serum H-FABP before discharge from hospital may be an independent predictor for critical cardiac events in DCM.

Abbreviations: BNP, brain natriuretic peptide; cTnT, cardiac troponin T; DCM, dilated cardiomyopathy; H-FABP, heart-type fatty acid binding protein

Keywords: brain natriuretic peptide; cardiac events; cardiomyopathy; fatty acid binding protein

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