Abstract
IntroductionMechanisms of maintenance of both atrial fibrillation and structural left ventricular disease are known to include fibrosis. Galectin-3, a biomarker of fibrosis, is elevated both in patients with heart failure and persistent atrial fibrillation. We sought to find whether galectin-3 has a prognostic value in patients with heart failure and a reduced left ventricular ejection fraction undergoing ablation of persistent atrial fibrillation.MethodsSerum concentrations of galectin-3 were determined in a consecutive series of patients with an ejection fraction ≤40%, addressed for ablation of persistent atrial fibrillation. Responders to ablation were patients in sinus rhythm and with an ejection fraction ≥50% at 6 months. A combined endpoint of heart failure hospitalization, transplantation and/or death was used at 12 months.ResultsSeventy-five patients were included (81% male, age 63±10 years, ejection fraction 34±7%, galectin-3 21±12 ng/mL). During follow-up, eight patients were hospitalized for decompensated heart failure, 1 underwent heart transplantation, and 4 died; 50 patients were considered as responders to ablation. After adjustment, galectin-3 level independently predicted both 6-month absence of response to ablation (OR = 0.89 per unit increase, p = 0.002). Patients with galectin-3 levels <26 had a 95% 1-year event-free survival versus 46% in patients with galectin-3 ≥26 ng/mL (p<0.0001).ConclusionsGalectin-3 levels independently predict outcomes in patients with reduced left ventricular systolic function addressed for ablation of persistent AF, and may be of interest in defining the therapeutic strategy in this population.
Highlights
Mechanisms of maintenance of both atrial fibrillation and structural left ventricular disease are known to include fibrosis
We sought to find whether galectin-3 has a prognostic value in patients with heart failure and a reduced left ventricular ejection fraction undergoing ablation of persistent atrial fibrillation
Galectin-3 levels independently predict outcomes in patients with reduced left ventricular systolic function addressed for ablation of persistent atrial fibrillation (AF), and may be of interest in defining the therapeutic strategy in this population
Summary
Serum concentrations of galectin-3 were determined in a consecutive series of patients with an ejection fraction 40%, addressed for ablation of persistent atrial fibrillation. Responders to ablation were patients in sinus rhythm and with an ejection fraction !50% at 6 months. A combined endpoint of heart failure hospitalization, transplantation and/or death was used at 12 months. Consecutive patients !18 years old with symptomatic persistent AF referred to our department for ablation between January 2013 and December 2015 were analyzed. Patients with the association of symptomatic HF and an LVEF 40% were included. Patients with a prior ablation for AF and those in sinus rhythm at the time of baseline echocardiographic evaluation were excluded. Collected clinical data included symptoms and history of arrhythmia, presence of risk factors, past and current medications. Transthoracic echocardiography was systematically performed before ablation
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