Plasma heart-type fatty acid binding protein is superior to troponin and myoglobin for rapid risk stratification in acute pulmonary embolism

Clin Chim Acta. 2006 Sep;371(1-2):117-23. doi: 10.1016/j.cca.2006.02.032. Epub 2006 May 15.


Background: Irreversible right ventricular (RV) failure with myocardial damage may precipitate fatal outcome in acute pulmonary embolism (APE). Cytoplasmic heart-type fatty acid binding protein (H-FABP) is a sensitive and specific biomarker of myocardial damage. We assessed which biomarker of myocardial damage or RV stretching is the most useful for short-term risk stratification in APE.

Methods: We analyzed 77 patients (51 F, 26 M) aged 65.3+/-16.0 years with confirmed APE. On admission, systemic blood pressure and transthoracic echocardiography (for RV overload) were recorded and plasma concentrations of myoglobin (Mb), cardiac troponin T (cTnT), N-terminal fragment of proBNP (NT-proBNP) and H-FABP were evaluated.

Results: Fifteen (19.5%) patients died and 24 (31.2%) experienced complicated clinical course (CCC)-death/thrombolysis/cardiopulmonary resuscitation/intravenous vasopressors. Hazard ratio analysis demonstrated that plasma H-FABP, Mb, cTnT and NT-proBNP concentrations predicted fatal outcome. When only APE-related deaths were considered, plasma H-FABP concentrations indicated fatal outcome. Multivariate hazard ratio analysis revealed H-FABP as the only 30-day mortality predictor (HR 1.02 CI 95% 1.01-1.05).

Conclusions: H-FABP measured on admission is useful for short-term risk stratification in APE. It appears to be superior to cTnT, NT-proBNP and Mb in the prediction of 30-day APE-related mortality.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Blood Pressure
  • Cardiopulmonary Resuscitation
  • Echocardiography
  • Fatty Acid-Binding Proteins / blood*
  • Humans
  • Middle Aged
  • Myoglobin / blood*
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / blood*
  • Prognosis
  • Pulmonary Embolism / blood
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / mortality
  • Risk Assessment / methods
  • Thrombolytic Therapy
  • Troponin / blood*
  • Vasoconstrictor Agents / pharmacology


  • Biomarkers
  • Fatty Acid-Binding Proteins
  • Myoglobin
  • Peptide Fragments
  • Troponin
  • Vasoconstrictor Agents
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain