Prognostic Value of Changes in Galectin-3 Levels Over Time in Patients With Heart Failure: Data From CORONA and COACH

Study Questions:

Does serial assessment of galectin-3 (Gal-3) plasma levels identify heart failure (HF) patients at increased risk of future morbidity and mortality?

Methods:

This manuscript assessed data from two studies, and included 1,329 patients from the CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure) trial with chronic HF, and 324 patients from the COACH (Coordinating Study Evaluating Outcomes of Advising and Counseling Failure) trial with acutely decompensated HF. All patients had Gal-3 plasma levels obtained at baseline and after follow-up of 3 months (CORONA) or 6 months (COACH). The study evaluated the relationship between changes in Gal-3 over time, as well as adverse events (composite all-cause mortality or HF rehospitalization). Patients were characterized using a threshold Gal-3 level of 17.8 ng/ml or a ≥15% change from baseline.

Results:

Baseline characteristics in patients from the CORONA and COACH studies included mean ages of 72 ± 7 and 70 ± 12 years, female gender in 23% and 40%, and New York Heart Association class ≥III in 68% and 51% of patients, respectively. A ≥15% increase in Gal-3 was associated with greater rates of adjusted all-cause mortality or HF rehospitalization for patients from the CORONA (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.2-1.9; p = 0.001) and COACH studies (HR, 2.0; 95% CI, 1.03-3.8; p = 0.04), whereas a decrease of ≥15% in Gal-3 was not associated with a significant difference in this adjusted composite outcome for either the CORONA (p = 0.17) or COACH (p = 0.18) studies. When outcomes were stratified by high (≥17.8 ng/ml) or low Gal-3 level, the highest to lowest composite event rates were observed, with those having Gal-3 levels at baseline and follow-up that were high and high, low and high, high and low, and low and low, respectively (p < 0.001 between groups).

Conclusions:

The authors concluded that serial changes in Gal-3 plasma levels may be useful to identify patients with HF who are at increased risk of future death or HF rehospitalization.

Perspective:

Defining the prognosis of HF patients based on history and examination alone can be challenging, and the use of biomarkers has some appeal in their potential ability to improve identification of patients at higher risk of adverse events. An increase in Gal-3 between baseline and follow-up was associated with greater risk of future mortality or readmission for HF in each of two distinct HF cohorts, and Gal-3 changes provided incremental prognostic information over risk factors and baseline B-type natriuretic peptide alone. More data are needed to determine whether treatment based on Gal-3 is associated with a meaningful clinical benefit in HF patients.

Clinical Topics: Heart Failure and Cardiomyopathies, Statins, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Fluorobenzenes, Follow-Up Studies, Pyrimidines, Risk Factors, Galectin 3, New York, Heart Diseases, Natriuretic Peptides, Prognosis, Incidence, Biological Markers, Cardiology, Heart Failure, Sulfonamides


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