Could heart-type fatty acid binding protein predict clinical outcome in coronary artery bypass graft surgery?

Mohamed  Aboelnasr; Wael Elfeky; Dina Adam Ali; Ghada Al-Ashmawy; Ayman Sallam

doi:10.35810/ects.v1i4.81

Mohamed Aboelnasr Cardiothoracic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Wael Elfeky Cardiothoracic Surgery Department, Faculty of Medicine, Kafr Elshiekh University, Kafr Elshiekh, Egypt
Dina Adam Ali Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Ghada Al-Ashmawy Biochemistry Department, Faculty of Pharmacy, Tanta University, Tanta, Egypt
Ayman Sallam Cardiothoracic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt

DOI: https://doi.org/10.35810/ects.v1i4.81

Keywords: Heart fatty acid binding protein (h-FABP), Coronary artery bypass graft (CABG) surgery, Myocardial injury, CK-MB

Abstract

Background: Detection of myocardial damage and its degree during open heart surgery were studied previously using different biomarkers. Heart fatty acid binding protein (h-FABP) was used in the diagnosis of myocardial infarction with variable results. In this study, we aimed to find the possibility of the use of this biomarker as a predictor of myocardial damage after coronary artery bypass graft (CABG) surgery.

Methods: We conducted a prospective study on 47 patients who had CABG surgery. Blood samples (4 ml) were drawn from patients at 5 points: before induction of anesthesia, after aortic declamping, 1 hour after declamping, 6 hours after declamping and one day after surgery. Levels of h-FABP and creatine kinase muscle/brain (CK-MB) were estimated, and the relationship between h-FABP and operative and postoperative outcomes were recorded.

Results: There were statistically significant correlations between higher levels of h-FABP measured immediately after aortic declamping and need for intra-aortic balloon (116.55 + 9.26 vs, 84.34 + 19.55 ng/ml; p= 0.022), inotropes (107.04+ 14.79 vs, 79.95 + 17.59ng/ml; p< 0.001), defibrillators (97.73 + 15.18 vs 81.59 + 20.31 ng/ml; p=0.016), and postoperative atrial fibrillation (99.94 + 17.83 vs 80.84 + 18.89ng/ml; p= 0.004). No mortality was detected in our study. h-FABP levels showed an early peak just after aortic declamping and reached baseline by postoperative day one. CK-MB peaked 1 hour after aortic declamping and remained elevated for more than 24 hours.

Conclusion: h-FABP is a cardiac biomarker that could be used as a rapid indicator of ventricular dysfunction and atrial fibrillation post-CABG surgery.