Role of Heart-Type Fatty Acid-Binding Protein (H-FABP) as a Prognostic Biomarker in Cardiovascular Diseases: Review Article

Heart-type fatty acid-binding protein (H-FABP) is a small cytoplasmic protein primarily expressed in cardiomyocytes, facilitating the transportation of fatty acid (FAs). Released rapidly into circulation following myocardial injury because of its soluble nature and small size (fifteen kilodalton), H-FABP peaks at four-six hours’ post-injury and returns to baseline within twenty-four hours, offering advantages over structurally bound markers like cardiac troponin (cTn) for early detection and risk stratification. While established as an early diagnostic biomarker for acute myocardial infarction (AMI), emerging evidence highlights H-FABP's prognostic utility beyond AMI. In acute coronary syndromes (ACS), elevated levels (>9.8 ng/mL) predict 6-18-month mortality and non-fatal AMI, independent of hs-cTn. In congestive heart failure (CHF), H-FABP outperforms BNP/NT-proBNP in forecasting outcomes, including mortality and readmissions in both chronic and acute decompensated cases. For pulmonary embolism (PE), it identifies subclinical right ventricular dysfunction, serving as the potent predictor of 30-day death in meta-analyses. Additionally, in post-coronary artery bypass grafting (CABG), H-FABP predicts long-term mortality and ventricular dysfunction superior to cTn. Despite specificity limitations, H-FABP's integration with hs-cTn enhances risk classification in troponin-negative high-risk patients, supporting its role in personalized cardiovascular care and outcome-oriented algorithms.