• Walid Ahmad Abbasi Rawalpindi Institute of Cardiology
  • Muhammad Saleem Rawalpindi Institute of Cardiology
  • Shahid Rashid Rawalpindi Institute of Cardiology
  • Azhar Mahmood Kayani Rawalpindi Institute of Cardiology


Background: Acute coronary syndrome remains a dominant cause of high morbidity and mortality despite advancements in treatment This study was conducted to examine the utility of point-of-care test of heart-type fatty-acid binding protein (h-FABP) and compare it with the point-of-care test of cardiac troponin I (cTnI) in the first 06 hours of STEMI. Methods: This cross-sectional, comparative study which was conducted in Rawalpindi institute of cardiology, Rawalpindi, Pakistan, from January to June 2015. Serum samples of 125 patients with the diagnosis of STEMI, presenting with chest pain of less than 6 hours’ duration, were analysed for quantitative and qualitative determination of h-FABP and cardiac troponin I (cTnI) using rapid immunochromatographic technique in the emergency department. Samples were taken at presentation and after 12 hours. Results: Out of 125 patients, 112 were males and 13 were females with a mean age of 54.26±9.53 years. The average symptom-to-sample time was 3.19±1.44 hours (median 3 hours). Mean h-FABP levels were significantly higher than the mean cTnI levels (29.10±30.66 vs 0.94±2.02; p=0.000). Overall, H-FABP was more sensitive than cTnI (72% vs 26.4%). The sensitivity of cTnI within 0–2, 2–4, and 4–6 hours of symptom onset was calculated to be 0%, 17.7%, and 75.9%, whereas sensitivity of H-FABP was 35.3%, 79.03% and 100% respectively. There was not a single patient who was cTnI positive and H-FABP negative as compared to 57 patients who were FABP positive and cTnI negative. Conclusion: h-FABP is a promising cardiac biomarker for the early identification of myocardial ischemia and infarction. It could be a superior biomarker for earlier detection of ACS and screening of patients with non-cardiac chest pain.Keywords: Heart type fatty acid protein; ST-segment elevation myocardial infarction; Troponin I, STEMI

Author Biographies

Walid Ahmad Abbasi, Rawalpindi Institute of Cardiology

Department of Cardiology; post graduate resident

Muhammad Saleem, Rawalpindi Institute of Cardiology

Department of Cardiology; Senior Registrar

Shahid Rashid, Rawalpindi Institute of Cardiology

Department of Cardiology; Senior Registrar

Azhar Mahmood Kayani, Rawalpindi Institute of Cardiology

Department of Cardiology; Executive director


Kolansky DM. Acute coronary syndromes: morbidity, mortality, and pharmacoeconomic burden. Am J Manag Care 2009;15(2 Suppl):S36–41.

Marceau A, Samson JM, Laflamme N, Rinfret S. Short and Long-Term Mortality after STEMI versus NON-STEMI: A Systematic Review and Meta-Analysis. J Am Coll Cardiol 2013;61(10):E96.

Rosman J, Kavala G, Obunai K, Bergmann SR. The role of heart-type fatty acid-binding protein in the diagnosis of acute coronary syndrome. Int J Angiol 2009;18(2):79–81.

Kim KS, Lee HJ, Kim K, Jo YH, Kim TY, Lee JH, et al. Heart-type Fatty Acid Protein as an Adjunct to Cardiac Troponin-I for the Diagnosis of Myocardial Infarction. J Korean Med Sci 2011;26(1):47–52.

Banu S, Tanveer S, Manjunath CN. Comparative study of high sensitivity troponin T and heart-type fatty acid-binding protein in STEMI patients. Saudi J Biol Sci 2015;22(1):56–61. Ref 5&11 are same

Banu KY, Niyazi OD, Erdem C, Afsin DH, Ozlem U, Yasmin C, et al. Value of heart-type fatty acid-binding protein (H-FABP) for emergency department patients with suspected acute coronary syndrome. Afr Health Sci 2014;14(3):757–62.

Seino Y, Tomita Y, Takano T, Ohbayashi K. Office cardiologists cooperative study on whole blood rapid panel tests in patients with suspicious Acute myocardial infarction: comparison between heart-type fatty acid-binding protein and troponin T tests. Circ J 2004;68(2):144–148.

Naroo GY, Ali SM, Butros V, Al Haj A, Muhammad I, Alosert M, et al. Elevated heart-type fatty acid-binding protein predicts early myocardial injury and aids in the diagnosis of non-ST elevation myocardial infarction. Hong Kong J Emerg Med 2009;16:141–7.

Liebetrau C, Möllmann H, Nef H, Szardien S, Rixe J, Troidl C, et al. Release kinetics of cardiac biomarkers in patients undergoing transcoronary ablation of septal hypertrophy. Clin Chem 2012;58(6):1049–54.

Chandran PA, Wani BA, Satish OS, and Mohammed N. Diagnosis of Non-ST-Elevation Acute Coronary Syndrome by the Measurement of Heart-Type Fatty Acid Binding Protein in Serum: A Prospective Case Control Study. J Biomark 2014;2014:624930.

Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infection. Circulation 2012;126(16):2020–35.

Alhashemi JA. Diagnostic accuracy of a bedside qualitative immunochromatographic test for acute myocardial infarction. Am J Emerg Med 2006;24(2):149–55.

Pantegni M, Pagani F, Bonetti G. The sensitivity cardiac markers: an evidence-based approach. Clin Chem Lab Med 1999;37(11-12):1097–106.

Than M, Cullen L, Aldous S, Parsonage WA, Reid CM, Greenslade J, et al. Two-hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol 2012;59(23):2091–8.

Cullen L, Muller C, Parsonage WA, Wildi K, Greenslade JH, Twerenbold R, et al. Validation of high-sensitivity troponin I in a 2-h diagnostic strategy to assess 30-day outcomes in emergency-department patients with possible acute coronary syndrome. J Am Coll Cardiol 2013;62(14):1242–9.

Reichlin T, Schindler C, Drexler B, Twerenbold R, Reiter M, Zellweger C, et al. One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med 2012;172(16):1211–8.

Keller T, Zeller T, Peetz D, Tzikas S, Roth A, Czyz E, et al. Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med. 2009;361(9):868–77.

Reichlin T, Hochholzer W, Bassetti S, Steuer S, Stelzig C, Hartwiger S, et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 2009;361(9):858–67.

Hall TS, Hallén J, Agewall S, Atar D, Jensen T. Changes in diagnosing non-ST-segment elevation myocardial infarction after the introduction of a new high-sensitivity cardiac troponin T assay: a single-centre experience. Clin Lab 2012;58(9-10):1029–36.

Randox. H-FABP Biomarker of mayocardial ischemia. [Internet]. 2013 Randox Laboratories Ltd [Cited 2015 Aug 1]. Available from: http://www.h-fabp.com/

Haastrup B, Gill S, Kristensen SR, Jorgensen PJ, Glatz JF, Haghfelt T, et al. Biochemical markers of ischemia for early identification of acute myocardial infarction without ST segment elevation. Cardiology 2000;94(4):254–61.

Singer AJ, Williams J, Taylor M, Le Blanc D, Thode HC Jr. Comprehensive bedside point of care testing in critical ED patients: a before and after study. Am J Emerg Med 2015;33(6):776–80.

Singer AJ, Ardise J, Gulla J, Cangro J. Point-of-care testing reduces length of stay in emergency department chest pain patients. Ann Emerg Med 2005;45(6):587–91.

Huang CH, Tsai MS, Chien KL, Hsu CY, Chang WT, Wang TD, et al. Prognostic relevance of plasma heart-type fatty acid binding protein after out-of-hospital cardiac arrest. Clin Chim Acta 2014;435:7–13.

Matsumoto S, Nakatani D, Sakata Y, Suna S, Shimizu M, Usami M, et al. Elevated serum heart-type fatty acid-binding protein in the convalescent stage predicts long-term outcome in patients surviving acute myocardial infarction. Circ J 2013;77(4):1026–32.

Viswanathan K, Kilcullen N, Morrell C, Thistlethwaite SJ, Sivananthan MU, Hassan TB, et al. Heart-type fatty acid-binding protein predicts long-term mortality and re-infarction in consecutive patients with suspected acute coronary syndrome who are troponin-negative. J Am Coll Cardiol 2010;55(23):2590–8.

Body R, McDowell G, Carley S, Wibberley C, Ferguson J, Mackway-Jones K. A FABP-ulous 'rule out' strategy? Heart fatty acid binding protein and troponin for rapid exclusion of acute myocardial infarction. Resuscitation 2011;82(8):1041–6.

Xu Q, Chan CP, Cao XY, Peng P, Mahemuti M, Sun Q, et al. Cardiac multi-marker strategy for effective diagnosis of acute myocardial infarction. Clin Chim Acta 2010;411(21-22):1781–7.




Most read articles by the same author(s)