| Objective:To investigate the expression level of Galectin-3(Gal-3)in patients with chronic heart failure with preserved left ventricular ejection fraction and to evaluate its diagnostic value and predictive value for short-term adverse prognosis.Methods:193 patients diagnosed with chronic heart failure and 103 patients without symptoms and signs of heart failure were selected from the Department of Cardiology,affiliated Hospital of Qingdao University from June 2017 to May 2018.According to the state of heart failure,they were divided into three groups:non-heart failure(Non-HF)group(103 cases,LVEF≥50%),heart failure with preserved ejection fraction(HFpEF)group(107cases,LVEF≥50%)and heart failure with reduceded ejection fraction(HFrEF)group(86 cases,LVEF<50%).Baseline data,biochemical indexes,B-type natriuretic peptide N-terminal peptide(NT-proBNP),echocardiography and other data were collected from three groups of patients and the serum Gal-3 levels were measured at the same time.Six-month follow-up was performed to observe the occurrence of heart failure rehospitalization and all-cause death.The diagnostic value and short-term prognostic value of Gal-3 in patients with chronic HFpEF were analyzed and compared with NT-proBNP,the traditional heart failure marker.Results:(1)Compared with Non-HF group and HFrEF group,there were more patients with hypertension and higher body mass index(BMI)in HFpEF group(P<0.05).The proportion of cardiac function II was higher in the HFpEF group than in the HFpEF group(47.7%vs.29.1%),and the difference was statistically significant(c~2=9.718,P<0.05);The hs-cTnI levels in HFpEF and HFrEF groups were higher than those in Non-HF.There was no statistically difference in hs-cTnI levels between HFpEF and HFrEF groups.(0.035ng/mL vs.0.043ng/mL,P>0.05).Comparison of echocardiography results showed that the left ventricular ejection fraction(LVEF)in HFpEF group was higher than that in HFrEF(62%vs.42%,P<0.05),while the left ventricular end diastolic diameter(LVEDD)and left atrial diameter(LAD)were lower than those in HFrEF group,and the difference was statistically significant(4.9cm vs.5.5 cm,4.2 cm vs.4.6 cm,P<0.05).There was no significant difference between other clinical data between the groups(all P>0.05).(2)The serum levels of Gal-3 and NT-proBNP in patients with chronic heart failure were significantly higher than those in patients without heart failure.The levels of Gal-3 and NT-proBNP in HFrEF group were higher than those in HFpEF group,and the difference was statistically significant(26.48ng/mL vs.21.13ng/mL,3051.52pg/mL vs.872.10pg/mL,all P<0.05).In the HFpEF group and HFrEF group,the higher the NYHA cardiac function grade,the higher the serum Gal-3 level,and the difference was statistically significant between the groups(P<0.01).(3)In the HFpEF group,Gal-3 was positively correlated with NT-proBNP and LAD,respectively.(r=0.318,0.301,P<0.01).In HFrEF group,Gal-3 was positively correlated with NT-proBNP(r=0.340,P<0.01),and negatively correlated with LVEF(r=-0.221,P<0.05).(4)When ROC curve method was used to distinguish HFpEF group and Non-HF group,the ROC-AUC of HFpEF diagnosed by NT-proBNP was significantly higher than that of Gal-3,and the difference was statistically significant(AUC:0.874 vs.0.819,Z=1.714,P<0.05).When the HFpEF group and the HFrEF group were distinguished,the ROC-AUC of HFpEF diagnosed by NT-proBNP was significantly higher than that of Gal-3,and the difference was statistically significant(AUC:0.901 vs.0.792,Z=4.281,P<0.05).(5)After a mean follow-up of six months,a total of 54 patients appeared endpoint events.There were 22 cases(25.6%)in the HFrEF group and 32 cases(29.9%)in the HFpEF group,and there was no significant difference in the incidence of endpoint events between the two groups(c~2=0.677,P>0.05).The ROC curve method was used to evaluate the predictive value of NT-proBNP and Gal-3 for endpoint events.The ROC-AUC of Gal-3was greater than NT-proBNP in the HFpEF group,and the difference was statistically significant(AUC:0.914 vs.0.807,Z=3.532,P<0.05);There was no significant difference in ROC-AUC of Gal-3 and NT-proBNP in HFrEF group(AUC:0.835 vs.0.848,Z=0.425,P>0.05).The HFpEF and HFrEF groups were divided into two groups based on the cut-off values of Gal-3 and NT-proBNP predicting endpoint events.The survival curve was drawn and the results suggest that high-level Gal-3(>22.52ng/mL,>26.71ng/mL)and NT-proBNP(>1838.45pg/mL,>4025.06pg/mL)in the HFpEF and HFrEF group have a higher risk of endpoint events compared with patients with low levels of Gal-3 and NT-proBNP during the follow-up of six months.The log-rank test statisticc~2 values were13.812,8.825,7.107,and 11.180,all P<0.05.Conclusion:(1)Patients with HFpEF and HFrEF have higher levels of Gal-3 than patients with non-heart failure.(2)Serum Gal-3 levels in patients with HFpEF and HFrEF are associated with severity of cardiac function and can improve the accuracy of cardiac function risk stratification.(3)The predictive value of Gal-3 for short-term poor prognosis of HFpEF is higher than that of NT-proBNP.Serum Gal-3 can be used as a good biomarker for HFpEF prognosis assessment,providing a more objective and accurate basis for the prognosis assessment of HFpEF. |
