H-FABP, cardiovascular risk factors, and functional status in asymptomatic spinal cord injury patients
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l1 · A. Kurtaran2 · B. Selçuk2 · M. Akyüz2 1 Department of Physical Medicine and Rehabilitation, Çanakkale Onsekiz Mart
UniversityEducation and Research Hospital, Kepez, Çanakkale 2 Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ministry of Health, Ankara
H-FABP, cardiovascular risk factors, and functional status in asymptomatic spinal cord injury patients Cardiovascular diseases are the major cause of death in spinal cord injury (SCI) patients [1]. Numerous recent studies have found that SCI is closely associated with atherosclerotic cardiovascular diseases. Previous studies have identified multiple risk factors in SCI patients including sedentary lifestyles, disorders of glucose metabolism, reduction of high-density cholesterol levels (HDL-C), and elevation of triglyceride and low-density lipoprotein cholesterol (LDL-C) levels and the presence of metabolic syndrome (MetS). Impairment of autonomic nervous control is associated with cardiac arrhythmias, hypotension, autonomic dysreflexia, and reduced venous return to the heart. Although patients with SCI may have significant coronary artery disease (CAD), they can be clinically asymptomatic. There are two reasons for the asymptomatic status of SCI patients: First, these patients have a reduced level of physical activity and even if significant cardiovascular diseases were present, the low blood volume into the heart can be sufficient. Another reason may be the decreased sensory feedback of angina. Several cardiac imaging methods were used in studies to detect asymptomatic cardiac diseases [2, 3]. These studies showed that silent coronary artery diseases were detected more than expected. However, these imaging methods are neither easy to use nor cost-effective. Furthermore, inadequate exercise capacity in SCI patients may lead to suboptimal imaging [4]. Hence, there is a need to develop new methods and serum markers
for the detection of asymptomatic CAD in this patient population. Fatty acid-binding proteins (FABPs) are a group of low-molecular-weight (14– 15 kDa) proteins. They are involved in the intracellular transport of long-chain bioactive fatty acids. Because of their small structure, they are secreted from injured cells in the early phase of any damage. Previous studies investigated the relationship between heart-type FABP (H-FABP) and myocardial injury. H-FABP is a sensitive and specific marker of myocardial injury owing to two important features. First, HFABP is abundant in the cytosol of cardiomyocytes compared to other tissues and it is undetectable under normal conditions. Second, H-FABP is a very small molecule (15 kDa) compared to troponin (37 kDa) or CK-MB (80 kDa). Therefore, H-FABP is released rapidly from cardiomyocytes into the circulation. H-FABP was also found to be superior to other cardiac enzymes in the detection of cardiovascular diseases [5, 6]. Several studies revealed that there were increased HFABP levels in patients with troponinnegative cardiovascular disease including obstructive sleep apnea syndrome, me
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