H-FABP as a Biomarker of Vascular Brain Damage in Transient Ischemic Attack
Daisy Guamán1, Elena Palà1, Paula García1, Anna Penalba1, Marcel Lamana 1, Alejandro Bustamante2, Jean Charles3, Sandrine Reymond3, Leire Azurmendi 4, Soledad Perez5, Marta Rubiera 6, Elvira Chocano1, Joan Montaner7, Alex Rovira8
1Neurovascular Research Laboratory Vall d’Hebron Institute of Research (VHIR) Universitat Autònoma de Barcelona Barcelona Spain, 2Department of Neurology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona (08916), Spain., 3Translational Biomarker Group, Internal Medicine Department, University Medical Center, University of Geneva, Geneva, Switzerland., 4Translational Biomarker Group, Internal Medicine Department, University Medical Center, University of Geneva, Geneva, Switzerland, 5Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville & Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain., 6Stroke, Unit, Department of Neurology, Hospital Universitari Vall d’Hebron, Barcelona Spain., 7Neurovascular Research Laboratory Vall d’Hebron Institute of Research (VHIR) Universitat Autònoma de Barcelona Barcelona Spain. Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville & Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain., 8Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Objective:
Our objective was to explore the potential value of heart fatty-acid binding protein (H-FABP) for the differential diagnosis of TIA versus mimics.
Background:
The accurate diagnosis of transient ischemic attack (TIA) appears to be a challenge in clinical practice.
Design/Methods:
A retrospective analysis with data from two large prospective cohorts was performed. We selected 175 patients from the StrokeChip multicenter study and 91 patients from a blood sample collection including patients diagnosed with TIA and available diffusion-weighted imaging (DWI) data. Blood was collected within 6 or 24 hours of symptom onset respectively. H-FABP was measured using a rapid Point-of-care-test (POCT). Biomarker levels were compared between TIA and mimics, and between positive and negative DWI lesions. Accuracy was evaluated with Receiver-operating-characteristic (ROC) curves. Cut offs were obtained using PanelomiX algorithms.
Results:
H-FABP levels were higher in patients with TIA compared to mimic [3.10 ng/mL (IQR 2.13 – 4.78) versus 1.70 ng/mL (IQR 1.23-2.38)] p <0.001. Discrimination Area under the curve (AUC) was 0.74 (95% CI: 0.64 – 0.83). The PanelomiX algorithm selected a cut off of >1.55ng/ml for H-FABP, and age >41.5 years; with a sensitivity of 89.00% and a specificity of 54.80%. A trend to higher concentrations was observed in those with acute DWI lesions [3.20 (IQR 2.40-4.10) vs. 2.40 (IQR 1.90–3.77) p=0.17].
Conclusions:
H-FABP could emerge as a potential diagnostic biomarker in clinical practice due to its ability to discriminate between patients with and without TIA. The quick and easy performance of POCT measurements allows its implementation in emergency departments and even in primary care centers.