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There is high incidence of perioperative cardiac mortality and morbidity in non-cardiac surgery. Heart-type Fatty Acid-Binding Protein (H-FABP) is a small cytoplasmic protein released from cardiac myocytes following an ischemic episode. It was shown that H-FABP is a useful prognostic marker in patients with suspected acute coronary syndrome who were troponin negative. The purpose of this study was to investigate H-FABP in detecting myocardial ischemia in patients who have clinical risk factors.
Sixty seven patients who have clinical risk factors, undergoing elective, intermediate risk, noncardiac surgery, were included. Blood specimens were analyzed for cTn-I and H-FABP levels before and 8 hours after surgery. A cutoff value of 7.5 ng/ml was used to define positive H-FABP levels, based on the 99th percentile for the 20 healthy controls. All patients 12-lead ECGs were obtained.
None of the patients had chest pain. The mean (±SD) age of patients was 65±11 years, 61.1% patients were male. Twenty seven (40%) patients had a history of ischemic heart disease, 3 (4.4%) patients had a history of heart failure. Five (7.5%) patients with cerebrovascular disease history, 40 (59.7%) patients with diabetes, 46 (68.6%) patients with hypertension were included. The mean duration of the operations was 2.33±1.27 hours. The prevalence of beta blockers and/or statin therapy in the patients undergoing the noncardiac surgery in this study was 35.8% (24/67 patients). Twenty seven patients have increased H-FABP. Only one of them has cTn-I >0.1 µg/L. The presence of diabetes was associated with increased H-FABP at the postoperative period (p=0.01). Seventy eight percent (21/27) of patients in the H-FABP ≥7.5 ng/ml group had diabetes. There is no significant correlation with other risk factors.
Diabetic patients may have increased pre-operative cardiac risk compared with other clinical risk factors. HFABP can be used in detecting subclinical myocardial ischemia as well as myocyte necrosis at the early phase of postoperative period.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Prevention: Diabetes and Risk
Abstract Category: 24. Prevention: Clinical
Presentation Number: 1185-2
- 2013 American College of Cardiology Foundation