The Prognostic Value of Heart Type Fatty Acid Binding Protein in Patients with Suspected Acute Coronary Syndrome: A Systematic Review.

BACKGROUND: Heart type fatty acid protein (HFABP) is a cytosolic protein released early after acute coronary syndrome (ACS) even in the absence of myocardial necrosis. OBJECTIVES: The purpose of this systematic review was to determine whether HFABP levels in patients with suspected, or confirmed ACS, improve risk stratification when added to established means of risk assessment. METHODS: We searched Medline, Pubmed and Embase databases from inception to July 2015 to identify prospective studies with suspected or confirmed ACS, who had HFABP measured during the index admission with at least 1 month follow up data. A prognostic event was defined as allcause mortality or acute myocardial infarction (AMI). RESULTS: 7 trials providing data on 6935 patients fulfilled inclusion criteria. There were considerable differences between studies and this was manifest in variation in prognostic impact of elevated HFABP(Odds ratio range 1.2-15.2 for death). All studies demonstrated that HFABP provide unadjusted prognostic information and in only one study this was negated after adjusting for covariates. A combination of both negative troponin and normal HFABP conferred a very low event rate. No study evaluated the incremental value of HFABP beyond that of standard risk scores. Only one study used a high sensitive troponin assay. CONCLUSION: There was marked heterogeneity in prognostic impact of HFABP in ACS between studies reflecting differences in sampling times and population risk. Prospective studies of suspected ACS with early sampling of HFABP in the era of high sensitivity troponin are necessary to determine the clinical value of HFABP. HFABP should not currently be used clinically as a prognostic marker in patients with suspected ACS.

The intersection of atrial fibrillation and heart failure in a hospitalised population.

OBJECTIVES: This work set out to comprehensively characterize patients admitted to hospital with both atrial fibrillation (AF) and heart failure (HF) and to compare this cohort of patients to the global hospital population of patients with only one of these diagnoses. METHODS AND RESULTS: This was a retrospective analysis of all in-patients with HF and AF admitted to a large urban hospital over a 3-month period. Patients with AF were identified by both discharge codes and electrocardiograms. HF patients were identified by means of discharge codes for HF and by screening all patients with AF, a common comorbidity of HF. Evidence for left ventricular (LV) dysfunction was sought. Of patients with AF (n = 453), 43% had symptoms of HF and LV dysfunction. Of patients with a discharge code and confirmed HF (n = 286), 34% had AF, 60% of whom were in chronic AF. Compared to HF patients in sinus rhythm those in AF were older (70 +/- 10 y vs 67 +/- 12 y, P < 0.02), had a higher prevalence of valvular heart disease (25% vs 7%, P < 0.0001) and a lower prevalence of ischaemic heart disease (17% vs 40%, P < 0.0001). HF patients identified by discharge codes in AF were more likely to have QRS > or = 120 msec (18% vs 12% in sinus rhythm; P= ns). Patients with AF and deemed to suffer concomitant HF, as opposed to AF alone, were significantly more likely to have QRS prolongation (QRS > or = 120 msec 27% vs 8%, P < 0.05). 8% of patients with AF and HF had a QRS > 150 msec. CONCLUSIONS: AF and HF are frequent, concomitant pathologies in a hospitalised population. AF complicates HF assessment and treatment. Greater dyssynchrony, as denoted by ECG, in the AF and HF population suggests opportunities for treatment of HF by cardiac resynchronization therapy and ablative therapies.