Utility of detection test for heart-type fatty acid–binding protein in postmortem blood

S. Matsumoto, K. Iwadate

Abstract: Background. Acute coronary syndrome (ACS) causes sudden death and is one of the most encountered diseases in the forensic category. There is an urgent need to establish an ACS diagnosis method. Although rapid detection tests for heart-type fatty acid–binding protein (H-FABP) are frequently used in clinical practice, the utility and accuracy of H-FABP rapid detection tests in postmortem blood are not known. Objectives. To evaluate the performance of the H-FABP rapid detection test using cardiac and femoral blood collected from 72 forensic autopsies performed between January 1, 2008, and May 31, 2012, and judged by the operator to be short in the agonal stage based on medical history and external findings. Methods. H-FABP rapid detection tests were performed using cardiac blood, H-FABP concentration was measured in the serum separated from cardiac and femoral blood, and statistical analyses were performed. Results. In the H-FABP negative group, as detected by the rapid detection test, the H-FABP concentration was significantly higher, and the sensitivity and specificity of ACS diagnosis were 0.524, and 0.667, respectively. When the H-FABP concentration was 6.2–2000 ng/mL, the rapid test produced true-positive results; false-negatives were first obtained at an H-FABP concentration of 5200 ng/mL. Conclusions. Our results suggest that H-FABP rapid detection tests are not suitable for use with postmortem blood, as high H-FABP concentrations were obtained regardless of the cause of death, and the risk of obtaining false-negative results was high at higher H-FABP concentrations.
Keywords: heart-type fatty acid–binding protein, H-FABP, postmortem blood, autopsy, rapid detection test.