Intraoperative h-FABP increase predicts postoperative increase in ischaemic markers

Objectives: h-FABP has prognostic value for early- and long-term outcomes in patients with acute coronary syndrome. Furthermore it has an earlier peak than TropT and TropI after myocardial damage. There are very limited data regarding utility of h-FABP levels in patients undergoing cardiac surgery. Aim of the present overview is to verify if h-FABP has diagnostic utility in decisions considering early postoperative hemodynamic instabilities.

Methods: 70 Patients (CABG n=49; Aortic/Mitral-Valve n=21; Age 67±10; male 57) undergoing elective cardiac surgery were recruited prospectively. Baseline clinical data and laboratory results were obtained. h-FABP levels were measured 30 minutes before and 30 minutes after cardiopulmonary bypass. Markers for cardiac ischemia (TropT, Myoglobin, CK/CK-MB) were measured at the same time. CK/CK-MB was measured 6 hours post CPB.

Results: Our results showed a significant h-FABP elevation (2.96±1.97ng/ml to 9.72±0.79; p<0.05), CK elevation (93.09±65.99U/l to 303.53±247,p<0.05), Myoglobin elevation (51.06±36.54µg/l to 329.43±219.98; p<0.05) as well as TropT elevation (0.04±0.09µg/l to 0.38±0.45; p<0.05) 30min. after CPB. A significant correlation between h-FABP-increase and CK-increase (p=0.03) as well as between h-FABP-increase and Myoglobin-increase (p=0.01) and between h-FABP-increase and TropT-increase (p=0.02) was found. Furthermore h-FABP 30min. post CPB showed a significnat correlation to CK/CKMB 6h post CPB (p=0.01). TropT increase did not correlate with any of the other markers.

Conclusions: This preliminary data indicates h-FABP is an early marker for cardiac injury after cardiosurgical operations. Its clinical value has to be determined in further prospective studies.