Plasma Galectin-3 Levels And Its Prognostic Value In Patients With Heart Failure

Objective: Heart failure (HF) remains one of the most prevalent and challenging medical conditions. Despite advances in treatment, morbidity and mortality remain high; 80% of men and 70% of woman aged 65 years or older will die within 8 years after the intial diagnosis. Thus, early diagnosis and treatment of HF was necessary for the outcome evaluation, i.e. short-term and long-term outcome evaluation of high risk patients. The fundamental mechanism for HF was cardiac remodeling. Brain natriuretic peptide (BNP) and NT-proBNP, main serologic markers of cardiac remodeling, were frequently used for the diagnosis, treatment and outcome evaluation. However, their concentrations in serum and blood plasma were influenced by various factors. Recent studies showed galectin-3 played important roles in the pathophysiology of HF. Moreover, studies in decompensated HF animal models showed that galectin-3 was involved in cardiac remodeling. However, few clinical studies were performed. Our aim is to study the association between plasma galectin-3 levels and cardiac structure, reduced and preserved ejection fraction, clinical value in patients with heart failure. And to evaluate the clinical prognostic value of plasma galectin-3 in patients with heart failure, 60 days follow-up was done by telephone.Methods: 76 patients with NYHA functional class I (n=16), class II (n=21), class III and IV (n=39) were included. The baseline clinical data were collected including age, gender, previous history and orally taken drugs. Serum galectin-3, NT-proBNP and heart color doppler ultrasound were examined. Except receiving conventional heart failure treatment, 39 patients with the NYHA functional class III or IV HF were randomized to intravenous recombinant human brain natriuretic peptide (rhBNP) (0.0075~0.01μg/kg/min, continuous intravenous pumping, 72h) or sodium nitroprusside (SNP) (0.1~0.5μg/kg/min, continuous intravenous pumping, 72h). Levels of galectin-3 and NT-proBNP were examined before and after one week treatment. Glactin-3 concentration was detected by enzyme linked immunosorbent assay (ELISA). Sixty days after discharge, telephone follow-up was performed to the HF patients to document the adverse events, such as death or readmission. Statistical analysis was performed by SPSS18.0 software. Level for statistical difference was P<0.05. Results: 1. NT-proBNP and galectin-3 showed remarkable increase in patients with NYHA Class III or IV HF compared with these of the patients of Class II (P<0.05).In addition, NT-proBNP and galectin-3 in patients with NYHA Class II showed remarkable higher than those of Class I patients (P<0.05).2. Levels of NT-proBNP and galectin-3 in patients with left ventricular ejection fraction (LVEF)≤40% showed significant increase compared with those of LVEF >40% (P<0.05). Galectin-3 levels of patients with left ventricular end-diastolic dimension (LVEDD) more than 70mm were higher than those of LVEDD ranged from 50mm to 70mm. And the levels of NT-proBNP and galectin-3 in patients with LVEDD 50-70mm were higher than those of the patients with LVEDD less than 50mm (P<0.05).3. Correlation analysis indicated galectin-3 level was positively correlated with NYHA classification (r=0.44,P<0.05) and LVEDD (r=0.41, P<0.05). No correlation was detected between NT-proBNP, galectin-3 and LVEDD (P>0.05).4. After anti-heart failure treatment, NT-proBNP and galectin-3 concentration showed significant reduction in effective group compared with baseline level (P<0.05). However, NT-proBNP and galectin-3 concentration was higher in no effective group compared with baseline level (P<0.05).5. After rhBNP treatment, NT-proBNP and galectin-3 levels showed significant decrease compared with the baseline level (P<0.05). For the SNP treatment group, slight decreases were detected in NT-proBNP and galectin-3, however, no statistical analysis was detected. For the cardiac color ultrasound, no significant difference was detected in left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension (LVEDD) 1 week after treatment compared with baseline level.6. During the 60 days telephone follow-up, NT-proBNP and galectin-3 levels of patients with adverse events were higher than those without adverse events (P<0.05).Conclusions:1. Galectin-3 level increases gradually with the deterioration of heart function, indicating that galectin-3 is associated with the extent of heart failure.2. Galectin-3 is associated with the progress of left ventricular remodeling.3. RhBNP theraphy is more effective in the anti-cardiac remodeling progress than SNP. 4. Patients with high level of NT-proBNP and galectin-3 have poor outcome within 60 days.