Cardiovascular Journal of Africa: Vol 26 No 6 (November/December 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 6, November/December 2015 208 AFRICA
the diagnosis of AMI.28 We used TnI as a marker in our study.
TnI is more commonly used today and it has been found to have
greater specificity for myocardial injury in chronic renal failure
patients than TnT.29
Similarly, in the study by Ruzgar et al.21 using a qualitative
H-FABP measurement, they determined the sensitivity of
H-FABP as 95% in the first six hours; however, patients with
ST-segment elevation were included in the study. We did not
include patients with ST-segment elevation in our study because
early diagnosis can be made without waiting for the results of
cardiac markers in patients with chest pain accompanied by
ST-segment elevation.
In a recent large study by McMahon et al.,30 H-FABP was
shown to have the highest NPV of all the individual markers in
the zero-to-three-hours admission time (93%) for early diagnosis
of MI/ACS. According this study, H-FABP was also a valuable
rule-out test for patients presenting three to six hours after the
onset of chest pain. Unlike our study, H-FABP was measured
quantitatively in this study.
The study by Figiel et al.31 showed similar results to ours. The
difference was that we focused on the time of admission from the
onset of symptoms, and determined the sensitivity, specificity,
NPV and PPV, since the primary benefit of a new biomarker
would be early, rapid and accurate diagnosis. H-FABP seemed to
be more sensitive than TnI, with a higher NPV in patients with
admission within three hours of onset of symptoms. It would be
possible to rule out NSTEMI diagnosis early in the course.
In our study, diagnostic sensitivity and specificity, and the
NPV and PPV of H-FABP were calculated as 83.3, 91.7, 84.6
and 90.6%, respectively, when all patients who were admitted
after less than 12 hours of symptoms were evaluated. When
compared with tnI and CK-MB, although the AI of H-FABP
was found to be greater, the main time interval of H-FABP was
superior to conventional markers at ≤ six hours. While the AI
of H-FABP was 85% in this period, the AI of TnI and CK-MB
were below this (65 and 62%, respectively, p < 0.05).
The importance of our study was that it included only patients
who had long-standing ischaemic-type chest pain, it excluded
patients with ST-segment elevation, and we used a qualitative
bedside method of H-FABP determination (CardioDetect). The
limitations of our study include the small number of patients,
it was a single-centre study, the study groups consisted of only
patients who had ischaemic-type chest pain, and H-FABP was
tested once only in every patient.
Conclusion
H-FABP appears to be a good diagnostic tool in the early period
of NSTEMI in patients admitted with ischaemic-type chest
pain. H-FABP could contribute to early bedside diagnosis in
emergency rooms, as it is more sensitive and specific than other
routinely used cardiac markers, such as TnI and CK-MB. This
is because it becomes elevated soon after MI. Our results need
to be confirmed with larger studies before routine use of this
procedure.
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