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Acute myocardial infarction (AMI) is a significant health problem owing to its high mortality rate. Heart-type fatty acid–binding protein (h-FABP) is an important biomarker in the diagnosis of AMI. In this work, an electrochemical h-FABP immunosensor was developed based on Cd 0.5 Zn 0.5 S/d-Ti 3 C 2 T x MXene (MXene: Transition metal carbide or nitride) composite as signal amplificator and core-shell high-crystalline graphitic carbon nitride@carbon dots (hc-g-C 3 N 4 @CDs) as electrochemical sensor platform. Firstly, a facile calcination technique was applied to the preparation of hc-g-C 3 N 4 @CDs and immobilization of primary antibody was performed on hc-g-C 3 N 4 @CDs surface. Then, the conjugation of the second antibody to Cd 0.5 Zn 0.5 S/d-Ti 3 C 2 T x MXene was carried out by strong π-π and electrostatic interactions. The prepared electrochemical h-FABP immunosensor was characterized by transmission electron microscopy (TEM), scanning electron microscopy (SEM), x-ray diffraction (XRD) method, Fourier-transform infrared spectroscopy (FTIR), x-ray photoelectron spectroscopy (XPS), cyclic voltammetry (CV), and electrochemical impedance spectroscopy (EIS). The prepared electrochemical h-FABP immunosensor indicated a good sensitivity with detection limit (LOD) of 3.30 fg mL −1 in the potential range +0.1 to +0.5 V. Lastly, low-cost, satisfactory stable, and environmentally friendly immunosensor was presented for the diagnosis of acute myocardial infarction. Graphical abstract

The utility of heart‐type fatty acid binding protein (H‐FABP) as a prognostic biomarker in light chain cardiac amyloidosis (AL‐CA) patients remains unestablished. Consecutive patients diagnosed with AL‐CA in the Heart Failure Center; Fuwai Hospital were enrolled. Baseline H‐FABP levels categorized patients as low (≤ 9.5 ng/mL) or high (> 9.5 ng/mL) group. Kaplan–Meier analysis and Cox proportional hazards models were performed. Model performance was assessed using Harrell's C concordance index (C‐index), integrated discrimination improvement (IDI) index, and net reclassification improvement (NRI) index. Eighty‐four patients were included (mean age 60.12 ± 11.25 years; 32.1% female), with 30 (35.7%) in the high H‐FABP group. Overall survival was significantly lower in the high H‐FABP group. In multivariable Cox models adjusted for age, eGFR and chemotherapy, H‐FABP > 9.5 ng/mL remained independently associated with an increased risk of all‐cause mortality when incorporating either the European modified Mayo 2004 stages [adjusted hazard ratio (HR): 2.79, 95% confidence interval (CI): 1.49–5.22; p = 0.001] or the revised Mayo 2012 stages (HR: 2.67, 95% CI: 1.48–4.83; p = 0.001). Adding H‐FABP levels significantly improved predictive performance across both baseline staging systems. For the European modified Mayo 2004 stage, the C‐index increased from 0.622 to 0.663, accompanied by positive IDI (0.053) and NRI (0.294). Similarly, for the revised Mayo 2012 stage, the C‐index increased from 0.611 to 0.660, with positive IDI (0.074) and NRI (0.308). Elevation of H‐FABP is associated with an increased risk of all‐cause mortality in patients with AL‐CA. It provides significant additive prognostic value to the established staging system for prognosis in AL‐CA. Study Highlights What Is the Current Knowledge on the Topic? Light chain cardiac amyloidosis (AL‐CA) is associated with high mortality, and risk stratification primarily depends on the European Modified Mayo 2004 staging system and the revised Mayo 2012 staging system that integrates cardiac biomarkers. However, substantial prognostic heterogeneity persists within stages. Heart‐type fatty acid–binding protein (H‐FABP), a marker of early myocardial injury, has prognostic value in other cardiovascular diseases, but its relevance in AL‐CA has not been established. What Question Did This Study Address? This study evaluated whether baseline H‐FABP levels are independently associated with all‐cause mortality in patients with AL‐CA and whether incorporating H‐FABP improves the prognostic performance of the European Modified Mayo 2004 staging system and the revised Mayo 2012 staging system. What Does This Study Add to Our Knowledge? In a prospective cohort of 84 AL‐CA patients, H‐FABP > 9.5 ng/mL remained independently associated with an increased risk of all‐cause mortality in multivariable Cox models adjusted for age, eGFR, and chemotherapy, when incorporating either the European modified Mayo 2004 stages [adjusted hazard ratio (HR): 2.79, 95% confidence interval (CI): 1.49–5.22; p = 0.001] or the revised Mayo 2012 stages (HR: 2.67, 95% CI: 1.48–4.83; p = 0.001). Adding H‐FABP levels significantly improved predictive performance across both baseline staging systems. For the European modified Mayo 2004 stage, the C‐index increased from 0.622 to 0.663, accompanied by positive IDI (0.053) and NRI (0.294). Similarly, for the revised Mayo 2012 stage, the C‐index increased from 0.611 to 0.660, with positive IDI (0.074) and NRI (0.308). How Might This Change Clinical Pharmacology or Translational Science? Incorporating H‐FABP into existing risk stratification frameworks may enhance baseline prognostic assessment in AL‐CA, allowing clinicians to better identify high‐risk patients who may benefit from closer surveillance or early therapeutic escalation. The proposed cutoff of 9.5 ng/mL offers a practical and implementable threshold for clinical use. These findings support further evaluation of H‐FABP–guided risk assessment and its potential integration into AL‐CA staging algorithms in future translational and clinical studies. Baseline heart‐type fatty acid binding protein (H‐FABP) independently predicts all‐cause mortality in patients with light chain cardiac amyloidosis (AL‐CA). Elevated H‐FABP levels (> 9.5 ng/mL) are associated with significantly worse survival and provide incremental prognostic value beyond established staging systems, improving risk stratification as reflected by increases in the C‐index, integrated discrimination improvement (IDI), and net reclassification improvement (NRI).

[This corrects the article DOI: 10.3389/fvets.2023.1089733.].

In forensic medicine, spotting signs of an acute myocardial infarction (AMI) right after it happens is still a tough call, especially in sudden-death cases. Standard histology often misses changes in those critical first hours because the tissue damage is too subtle to see. To tackle this, we reviewed research (1990–2023) from PubMed and Web of Science, following PRISMA guidelines. We focused on studies that used immunohistochemistry to identify markers of early AMI in both human autopsies and animal models, specifically in the first six hours post-event. Our selection process narrowed 418 records to 37 key papers. We screened 49 markers in total, but only a handful stood out for reliable diagnosis: C5b-9, cardiac troponins, dystrophin, and H-FABP—all showing high specificity. Markers like S100A1 and IL-15 also showed promise, whereas JunB and connexin-43 appeared less dependable. We believe immunohistochemistry can add real value in early AMI identification, especially when using combinations of markers chosen for complementary strengths. Still, to make this approach practical in forensic settings, we need more studies on human samples and agreement on standardized lab protocols.

Background: Heart failure (HF) remains one of the leading causes of death to date despite extensive research funding. Various studies are conducted every year in an attempt to improve diagnostic accuracy and therapy monitoring. The small cytoplasmic heart-type fatty acid-binding protein (H-FABP) has been studied in a variety of disease entities. Here, we provide a review of the available literature on H-FABP and its possible applications in HF. Methods: Literature research using PubMed Central was conducted. To select possible studies for inclusion, the authors screened all available studies by title and, if suitable, by abstract. Relevant manuscripts were read in full text. Results: In total, 23 studies regarding H-FABP in HF were included in this review. Conclusion: While, algorithms already exist in the area of risk stratification for acute pulmonary embolism, there is still no consensus for the routine use of H-FABP in daily clinical practice in HF. At present, the strongest evidence exists for risk evaluation of adverse cardiac events. Other future applications of H-FABP may include early detection of ischemia, worsening of renal failure, and long-term treatment planning.

IntroductionWe have previously shown that heart-type fatty acid binding protein (H-FABP) has a role in predicting all-cause mortality after acute coronary syndromes (ACS) and after multivariable analysis, provides additional information to that gained from the GRACE clinical risk factor score, troponin and highly sensitive CRP. H-FABP is released into the circulation during myocardial ischaemia and after myocardial necrosis, in contrast to troponin which is released after myocardial necrosis only. We have also shown that there is a group of ACS patients who are at high risk of cardiac events and death despite normal troponin levels on admission. This group may benefit from an early invasive strategy.HypothesisPlasma H-FABP level, taken between 12 and 24 h after admission, can identify troponin negative ACS patients who are at a high long term risk of death.MethodsSix-year mortality data is now available for patients enrolled in the FAB 1 study, for which 1-year mortality data was published in 2007. In this study, 1448 unselected patients admitted to hospital with ACS had serum H-FABP level measured in addition to usual care. Mortality was tracked by the UK Office of National Statistics.ResultsAt 6 years overall all-cause mortality, available for 1421 patients (98.1%), was 43.5%. If troponin −ve/H-FABP −ve mortality was 20.9%; troponin −ve/H-FABP +ve 56.4%; troponin +ve/H-FABP −ve 20.2%; troponin +ve/H-FABP +ve 49.1%. Mortality rate was independent of troponin status but strongly related to H-FABP status.ConclusionThe current system of stratification of ACS patients for early invasive management if troponin positive will miss a cohort of patients who are at high risk of death despite being troponin negative, and who may benefit from invasive investigation. Conversely, it is likely that some ACS patients undergo angiography based on a false positive troponin level. The addition of H-FABP measurement to the management of ACS could avoid this.Abstract 7 Figure 1

Immune checkpoint inhibitors (ICIs) have transformed the therapeutic landscape of oncology but are increasingly associated with cardiovascular immune-related adverse events (irAEs), including myocarditis, heart failure, arrhythmias, and vascular complications. Among these, ICI-associated myocarditis represents the most severe manifestation, often characterized by high mortality and challenging early diagnosis. Detecting subclinical myocardial injury before irreversible cardiomyocyte necrosis occurs remains a major unmet need in contemporary cardio-oncology. This narrative expert review critically examines the biological rationale, preclinical evidence, and emerging clinical data supporting the potential role of heart-type fatty acid-binding protein (H-FABP) as an adjunctive biomarker of early immune-mediated myocardial injury during ICI therapy. H-FABP is a small cytosolic lipid chaperone abundantly expressed in cardiomyocytes and rapidly released into the circulation following subtle membrane destabilization and metabolic stress, frequently preceding detectable troponin elevation in other forms of myocardial injury. Experimental studies support a mechanistic association between H-FABP release, inflammasome activation, cytokine amplification, mitochondrial dysfunction, and immune-metabolic cardiomyocyte stress. Preliminary clinical observations further suggest that H-FABP elevations may occur during ICI treatment even in the absence of overt myocarditis or concomitant increases in high-sensitivity cardiac troponins (hs-cTns). Although H-FABP cannot replace hs-cTn, which remains the cornerstone biomarker for the diagnosis of clinically significant ICI-associated myocarditis, its rapid kinetics and sensitivity to early metabolic membrane injury support its potential role as an investigational adjunctive biomarker for early surveillance and risk stratification. This approach may be particularly relevant in patients receiving high-risk combination ICI regimens or in individuals with pre-existing cardiovascular disease. However, current evidence remains limited, and large prospective multicenter studies integrating H-FABP with hs-cTns, natriuretic peptides, cardiac magnetic resonance imaging, and clinical outcomes are required before routine clinical implementation can be considered.

In terms of medicine, the prevention, diagnosis, and assessment of acute myocardial infarction (AMI) as well as the effectiveness of therapy all depend on the sensitive and early detection of human heart-type fatty acid–binding protein (H-HABP). The synthetic material used in this study, Ni-TCPP(Fe), has a unique structure that resembles a rifter with many thorns. When exposed to PSS-Gr, Ni-TCPP(Fe) would unfold into a sheet structure, exposing a lot of active sites and improving the catalytic active surface area, making it easier to detect H-FABP. We have successfully synthesized an electrochemical immunosensor based on Ni-TCPP(Fe)@PSS-Gr and Ag@Au/Pt as a signal label which demonstrated excellent sensor performance. A broad linear range of 10 fg/mL to 100 ng/mL with a low detection limit of 5.75 fg/mL (S/N = 5) for detecting H-FABP was obtained under ideal conditions. Furthermore, the detection results from the human serum samples were positive, suggesting that the made-up immunosensor could be useful for early clinical analysis.

Pulmonary embolism (PE) remains a major diagnostic and prognostic challenge in emergency departments due to its heterogeneous clinical presentation and potentially high mortality. Although echocardiography and conventional cardiac biomarkers are commonly used in clinical practice, the additional prognostic value of novel biomarkers such as copeptin and heart-type fatty acid-binding protein (H-FABP) requires further investigation. This exploratory prospective study (March 2021-September 2022) included adult patients (≥ 18 years) diagnosed with acute PE confirmed by radiological imaging in the emergency department. Patients with chronic/unconfirmed PE, incomplete data, or those referred from external centers were excluded. The primary analysis compared survivors and nonsurvivors at 30 days to evaluate the prognostic value of copeptin, H-FABP, and echocardiographic parameters. Transthoracic echocardiography (TTE) was performed after diagnosis to assess right heart function and pulmonary artery pressure (PAP), right ventricular/left ventricular ratio (RV/LV), right and left ventricular end-diastolic diameters (RV-EDD and LV-EDD), and tricuspid annular plane systolic excursion (TAPSE). Biomarkers (troponin, pro-BNP, D-dimer, copeptin, and H-FABP) were analyzed using standard laboratory assays and enzyme-linked immunosorbent assay (ELISA). The primary outcome was 30-day mortality. A total of 88 patients were analyzed. Although H-FABP and copeptin levels were higher in nonsurvivors, these differences were not statistically significant for predicting 30-day mortality. Echocardiographic parameters-particularly PAP, RV-EDD, and RV/LV-were significantly associated with the severity of right ventricular dysfunction and clinical outcomes ( < 0.05). In multivariable logistic regression analysis copeptin, H-FABP, PESI score, ICU admission, RV-EDD, and LV-EDD remained independently associated with 30-day mortality. Cut-off values were determined by ROC analysis using the Youden index. Although biomarkers were not significant as continuous variables, exploratory categorized analysis based on cut-off values suggested a potential association with mortality. Rapid bedside echocardiography combined with appropriate biomarker testing may improve risk stratification in patients with PE in emergency settings, while larger studies are needed to clarify the role of these biomarkers.

Objective: To evaluate the value of cardiac troponin(cTn), myoglobin(Myo) combined with heart-type fatty acid-binding protein(H-FABP) detection in the diagnosis of early acute myocardial infarction(AMI). Methods: This study was a clinical comparative study. Eighty patients with AMI hospitalized in Tangshan Workers’ Hospital were selected as study group, and another 80 individuals receiving normal physical examination were selected as control group from September 20, 2021 to September 20, 2022. The concentrations of cTn, Myo and H-FABPP, diagnostic indicators, the sensitivity and specificity of combined diagnosis, as well as the diagnostic efficacy for AMI were compared between the two groups. Results: The levels of cTn, Myo and H-FABPP in the study group were significantly higher than those in the control group(P= 0.00). Multivariate logistic regression analysis showed that cTn, Myo and H-FABP were all relevant indicators for AMI. H-FABP alone has better diagnostic efficacy for AMI. The area under the curve of their combined detection, the specificity, and the sensitivity were higher than those of cTn, Myo and H-FABP alone, indicating that their combined application has the best diagnostic efficiency. cTn, Myo and H-FABP levels were positively correlated with Glu, TC, LDL-C and hs-CRP levels(P< 0.01), while negatively correlated with HDL level(P< 0.01). Conclusions: The combined detection of cardiac markers such as cTn, Myo and H-FABP presents higher sensitivity and specificity in the diagnosis of AMI compared with any single detection, and can provide better data support for the definite diagnosis of AMI, with high clinical application value. doi: https://doi.org/10.12669/pjms.39.6.7101 How to cite this: Sun J, Liu X, Xing X, Yang Y, Xuan H, Fu B. Value of Cardiac Troponin, Myoglobin Combined with Heart-type Fatty Acid-binding Protein Detection in Diagnosis of Early Acute Myocardial Infarction. Pak J Med Sci. 2023;39(6):1690-1694.  doi: https://doi.org/10.12669/pjms.39.6.7101 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.