Usefulness of Plasma Galectin-3 Levels in Systolic Heart Failure to Predict Renal Insufficiency and Survival

Study Questions:

What is the relation between plasma galectin-3 levels and myocardial indexes of systolic heart failure (HF)?

Methods:

The investigators measured plasma galectin-3 in 133 subjects with chronic HF and 45 with advanced decompensated HF using echocardiographic and hemodynamic evaluations. Cox proportional hazards model was used to assess clinical risk associated with increasing continuous standardized increments of natural logarithm-transformed plasma galectin-3 levels.

Results:

In the chronic HF cohort, median plasma galectin-3 level was 13.9 ng/ml (interquartile range 12.1-16.9). Higher galectin-3 was associated with more advanced age (r = 0.22, p = 0.010), poor renal function (estimated glomerular filtration rate, r = −0.24, p = 0.007; cystatin C, r = 0.38, p < 0.0001), and predicted all-cause mortality (hazard ratio, 1.86; 95% confidence interval, 1.36-2.54; p < 0.001). In multivariate analysis, galectin-3 remained an independent predictor of all-cause mortality after adjusting for age, estimated glomerular filtration rate, left ventricular (LV) ejection fraction, and mitral early diastolic myocardial relaxation velocity at septal mitral annulus (hazard ratio, 1.94; 95% confidence interval, 1.30-2.91; p = 0.001). However, galectin-3 did not predict the combined endpoint of all-cause mortality, cardiac transplantation, or HF hospitalization (p > 0.05). Furthermore, there were no relations between galectin-3 and LV end-diastolic volume index (r = −0.05, p = 0.61), LV ejection fraction (r = 0.10, p = 0.25), or LV diastolic function (mitral early diastolic myocardial relaxation velocity at septal mitral annulus, r = 0.06, p = 0.52; left atrial volume index, r = 0.08, p = 0.41). In the advanced decompensated HF cohort, the investigators did not observe any relation between galectin-3 and echocardiographic or hemodynamic indexes.

Conclusions:

The authors concluded that high plasma galectin-3 levels were associated with renal insufficiency and poorer survival in patients with chronic systolic HF, but they did not observe a relation between galectin-3 and echocardiographic or hemodynamic indexes.

Perspective:

The study demonstrates the lack of a strong relation between galectin-3 and echocardiographic measurements of cardiac structure and function in chronic stable systolic HF or galectin-3, and invasive hemodynamic measurements in advanced decompensated HF and the relatively stronger relation between galectin-3 and indexes of renal dysfunction, including cystatin C levels. Taken together, these data suggest that galectin-3 is a pleiotropic molecule mediating immune response, inflammation, and fibrogenesis rather than specific to cardiac performance alone, and an association with renal impairment may in part determine its prognostic role in HF. Further investigations regarding the clinical utility of galectin-3 are indicated.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Acute Heart Failure, Chronic Heart Failure, Heart Failure and Cardiac Biomarkers, Echocardiography/Ultrasound

Keywords: Renal Insufficiency, Biological Markers, Ventricular Function, Left, Glomerular Filtration Rate, Galectin 3, Heart Failure, Systolic, Hospitalization, Hemodynamics, Echocardiography


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