Background• AMI – The most serious

challenge in cardiology. • H – FABP – human heart

specific fatty acid binding protein , has a high potential as a marker for early diagnosis of AMI.

• H- FABP is released early to the blood stream.

• Useful for both rapid confirmation & exclusion of infarction.

• NSTEMI, unstable angina – diagnosis is difficult.

• A rapid qualitative test cardio detect test – H-FABP

• Fatty acid binding protein are members of cytosolic protein family.

• Tissue specific abundant in heart, liver & intestine and are named H-FABP, L-FABP, I-FABP respectively.

• H – FABP consist of 132 amino acid and is present mainly in heart and liver.

Advantages:• High myocardial content.• Low molecular weight.• Relative tissue specificity.• Early (within 2 hrs ) appearance

in plasma &urine after AMI.• Can detect reinfarction –

normalisation of HFABP, occurs within 24 hrs.

• To evaluate the diagnostic value of early h – FABP detection compared to other selected markers of myocardial injury such as Troponin – I , Troponin – T level .

• Measuring the H- FABP using the qualitative test CardioDetect med in acute myocardial infarction.

Aims & Objectives

Methods

Conclusion

H-FABP AS AN EXCELLENT BIOCHEMICAL CARDIAC MARKER FOR DIAGNOSING ACUTE NON ST ELEVATION MI (NSTEMI)

IN FIRST 4 HOURS OF PRESENTATION TO AN ED.  Dr. Karthikeyan Sundaramurthy; Dr. Kesavardan Rddy Narsing*; Dr. Srihari Cattamanchi;

Dr. T.V. Ramakrishnan.Sri Ramchandra Medical College & Research Institute, Porur, Chennai – 600116. Tamil Nadu. India.

Results

Dr. Karthikeyan Subramanian; Mobile: +91-9843163160; Email id: winsomedoctor@gmail.com

Study Design: A prospective, diagnostic, analytical study Settings: Accident & Emergency Department at Sri Ramachandra Medical College & Research Institute, Porur, Chennai, Duration: Six Months from September 2009 to February 2010. Consecutive sampling technique employed. Methodology: Blood samples taken for Troponin T, Troponin I and H-FABPs as early as possible and sent for analysis. Instrument: A preformatted proforma was used as an instrument in the study. Inclusion Criteria: • ACS with out persistent ST

segment elevation in patients < 24 hr’s from the onset of chest pain .

• ECG features implying acute ischemia like ST segment depression, T wave pseudonormalisation, isolated T wave inversion .

• Without typical ischemic changes.

Exclusion Criteria:• ST elevation myocardial

infarction• Renal failure (creatinine >2mg/dl)• Skeletal muscle disorder.Data Collection: The patient's demographic data, presenting complaints past history, EKG changes and vitals are recorded. The values of Troponin T, Troponin I and H-FABPs are analyzed. Written informed consent was obtained Institutional Ethics Committee approval was obtained.Statistical analysis was done using SPSS software ver. 15.0.

• A total of 55 chest pain patients with equivocal ECG findings were enrolled in the study.

• There were 39 males and 16 females with mean age of 59.65 years.

• H-FABP had sensitivity of 83.63% and specificity of 98.18% compared with 62.21% and 98.46% for cTnT and 67.96% and 98.14% for cTnI in initial 4 hours after onset of chest pain.

• Altogether, 46 patients had acute myocardial infarction as confirmed by positive troponin levels (gold standard test).

• Qualitative h-FABP test (CardioDetect med) showed excellent sensitivity, higher than measurements of cTnI and cTnT in first 4 hours of hospital admission, and high specificity in patient group with NSTEMI.

• H-FABP is excellent biochemical cardiac marker for diagnosing NSTEMI, especially in its early phase, allowing exclusion of myocardial necrosis.

- : Negative+ : 20 to 40µg/L ++ : 80µg/L+++ : 160µg/L