The Role of Human Fatty Acid Binding Protein as an Early Predictive Biomarker for Carbon Monoxide Induced Cardiotoxicity (A Prospective study)

Abstract

Carbon monoxide poisoning is considered to be one of the leading causes of death worldwide and its neurological and cardiologic sequelae are the most frequent form of morbidity. Clinical features of the cardiac effects includes: arrhythmias, coronary spasm, ventricular dysfunction, myocardial infarction and sudden death. It is well-known that the presence of cardiac toxicity in CO poisoning increases short and long term mortality. Consequently, it is important to diagnose cardiac involvement rapidly in these patients. In severe CO intoxications, an increase in cardiac biochemical indicators in blood as: (creatine kinaseMB [CKMB], troponin I and T, myoglobin) and electro cardiographic (ECG) changes have been reported. Human fatty acid-binding protein (H-FABP) is a cytosolic protein abundantly present in myocardial tissue with small molecular weight; it plays a role in intracellular fatty acid transport. This protein has been recently used as a new marker since it is identifiable in serum by myocardial cell destruction. In contrast to myoglobin, HFABP is more specific than myoglobin and there is more fatty acid binding proteins in the heart compared to skeletal muscle and it can be identified earlier than CKMB and troponins in acute coronary syndromes. This study aimed to: assess the role of human fatty acid binding protein as an early predictor biomarker for carbon monoxide induced cardiotoxicity among patients admitted to The Poison Control Center Ain Shams University Hospitals. This prospective observational study was conducted on 25 adult (18-65years old) patients of both sex who were admitted to the Poison Control Center (PCCAUS) of Ain Shams University Hospitals, with acute moderate and sever CO intoxication, in the period starting from November 2015 to April 2016. The patients were divided into two groups (group I) of those with moderate CO poisoning and (group II) those with sever CO poisoning. Patients with age <18years old and those with age >65years old, history of mild carbon monoxide poisoning, suspecting chronic CO exposure due to nature of the work or due to smoking , ischemic disease patients, pregnant women and anemic were excluded from the study .Written informed consent was obtained from all patients.

All patients of both groups were subjected to the following: