Abstract
Aims. Galectin-3 is an emerging biomarker which has been studied in relatively small heart failure (HF) cohorts with predominantly systolic HF. We studied the prognostic value of base-line galectin-3 in a large HF cohort, with preserved and reduced left ventricular ejection fraction (LVEF), and compared this to other biomarkers.Methods. We studied 592 HF patients who had been hospitalized for HF and were followed for 18 months. The primary end-point was a composite of all-cause mortality and HF hospitalization.Results. A doubling of galectin-3 levels was associated with a hazard ratio (HR) of 1.97 (1.62–2.42) for the primary outcome (P < 0.001). After correction for age, gender, BNP, eGFR, and diabetes the HR was 1.38 (1.07–1.78; P = 0.015). Galectin-3 levels were correlated with higher IL-6 and CRP levels (P < 0.002). Changes of galectin-3 levels after 6 months did not add prognostic information to the base-line value (n = 291); however, combining plasma galectin-3 and BNP levels increased prognostic value over either biomarker alone (ROC analysis, P < 0.05). The predictive value of galectin-3 was stronger in patients with preserved LVEF (n = 114) compared to patients with reduced LVEF (P < 0.001).Conclusions. Galectin-3 is an independent marker for outcome in HF and appears to be particularly useful in HF patients with preserved LVEF.
Highlights
Progress has been made in early diagnosis and risk stratification of heart failure (HF), we are still short of tools to detect the disease early and to predict prognosis [1]
We investigated the predictive value of galectin-3 in HF due to HF with reduced ejection fraction (HFREF) or HF with preserved ejection fraction (HFPEF) and compared this to an established biomarker, NTpro-brain natriuretic peptide (NT-proBNP), and to several cytokines that have been associated with HF and that have been pathophysiologically related to galectin-3, including IL-6 and hsCRP
We separately analyzed the individual elements of the primary end-point: 164 deaths and 145 hospitalizations due to worsening HF (this number exceeds the number of hospitalizations (n 84) of the primary outcome, as some patients were hospitalized several times)
Summary
Progress has been made in early diagnosis and risk stratification of heart failure (HF), we are still short of tools to detect the disease early and to predict prognosis [1]. Several biomarkers are used for diagnosis and prognosis of HF patients. Galectin-3 has been proposed as a novel biomarker [2]. Galectin-3 is secreted by activated macrophages and modulates several physiological and pathological processes [3] that contribute to HF, including inflammation and fibrosis. The up-regulation of myocardial galectin-3 has initially been demonstrated in a rat model of HF-prone hypertensive hearts [4]. Elevated levels of plasma galectin-3 in patients with acute [5] and chronic HF [6,7,8] were consistently associated with adverse outcome
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