Clinical and diagnostic significance of heart fatty acid-binding protein (H-FABP) in cardiological practice

Objective: to summarize and systematize current data on the molecular functions of heart-type fatty acid-binding protein (H-FABP), its role in early diagnosis of acute coronary syndrome (ACS) and prognostic value in stable coronary artery disease (CAD) and chronic heart failure (CHF). Material and methods. A systematic literature search was performed in PubMed, Scopus, Web of Science, eLibrary databases from 1972 to 2025. Keywords: «heart-type fatty acid-binding protein», «H-FABP», «FABP3», «acute myocardial infarction», «stable coronary artery disease», «heart failure», «biomarker», «prognosis». Original clinical studies, meta-analyses and systematic reviews on diagnostic and prognostic value of H-FABP were selected. Results. H-FABP is a low-molecular-weight cytosolic protein (15 kDa) that mediates intracellular transport of long-chain fatty acids in cardiomyocytes. Due to rapid release upon membrane damage, it appears in blood within 1–3 h after coronary occlusion, peaks at 6–8 h, making it the most sensitive marker in the first hours of ACS (sensitivity > 90 %, negative predictive value up to 99 %). In ACS, elevated H-FABP (> 8 ng/mL) is associated with a 4–10-fold increased risk of death, recurrent infarction and heart failure within one year. In stable CAD patients, persistent elevation of H-FABP (cutoffs 2.7–4.5 ng/mL) reflects subclinical myocardial injury due to microvascular dysfunction, inflammation and metabolic stress and serves as an independent predictor of cardiovascular events up to 7 years (HR 2.5–5.0). In CHF, H-FABP concentration correlates with NYHA functional class, and its combination with NT-proBNP improves risk stratification for death and hospitalization (HR up to 5.68). In pulmonary embolism, H-FABP ≥ 6 ng/mL predicts 30-day complications with HR 10.04, outperforming troponins and NT-proBNP. Conclusions. H-FABP is a unique biomarker with dual clinical perspective: ultra-early diagnosis of acute myocardial injury and long-term risk stratification in chronic CAD and CHF. Standardization of cutoffs and investigation of its impact on therapeutic management are needed for widespread clinical implementation.

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