Application Value Of Galectin-3 In Patients With Heart Failure And Atrial Fibrillation

Objective To evaluate the value of plasma galectin-3（Gal-3）in the diagnosis,risk stratification and prognosis of heart failure（HF）,heart failure with atrial fibrillation（HF-AF）,and to suggest new clinical evaluation indicators of HF-AF.Methods HF patients（n=195,aged 40⁹4 years,120 males,and 75 females）who were hos-pitalized in TEDA International Cardiovascular Hospital between January 2018 to July 2018 were selected,as well as the healthy ones（n=21,age 41⁶4 years old,9males and 12 females）.According to pre-hospital presence of atrial fibrillation,HF patients were divided into sinus rhythm group（HF-SR,n=105,age 40⁸8 years old,62 males and 43 females）and HF-AF group（n=90,aged 47⁹4 years old,58 males and 32 females）.The basic data and plasma Gal-3 levels were compared between the two groups.Correlations were explored between Gal-3 concentration and baseline charac-teristic（age,gender,BMI,NYHA of heart function,alcohol and tobacco history）,echocardiographic parameters（left ventricular volume,diameter of heart chambers and LVEF）,plasma BNP concentration,eGFR,AF₂DS₂-VASc score,HAS-BLED score.The ROC curve was used to evaluate the diagnostic value of Gal-3for HF and HF-AF.All patients were followed up for 6 months,with HF readmission or all-cause death as the endpoint,and prognostic factors of HF/HF-AF patients were studied by multivariate cox regression analysis.K-M survival curve was used to explore the survival status of HF patients in different Gal-3 concentrations.Results 1NYHA classification,LVEF and BNP in the HFrEF,HFmrEF,HFpEF subgroup were significantly different（P<0.05）,there was no significant difference in the HF-AF,HF-SR subgroup（P>0.05）.2 The plasma Gal-3 concentration in HF/HF-AF patients was obviously higher than that in controls[HF 23.04（16.09⁴1.30）ng/mL,HF-AF25.78（17.24⁴4.56）ng/mL,healthy 14.39（12.08¹6.89）ng/mL,P<0.05];Gal-3 in patients with HFpEF-AF[23.05（15.99³7.23）ng/mL]was significantly higher than that in patients with HFpEF-SR[16.86（12.51²1.03）ng/mL]（P<0.05）.3 In HF/HF-AF patients,plasma Gal-3 was positively correlated with basic heart disease history（heart valve disease,cardiomyopathy）,NYHA,ALT and WBC（r>0,P<0.05）,and negatively correlated with eGFR（r<0,P<0.05）.In HF patients,plasma Gal-3 was also significantly positively associated with LVEDV,LVESV,LV-D,RV-D,plasma BNP and serum GGT concentration（r>0,P<0.05）,and obviously negatively correlated with LVEF（r<0,P<0.05）.Correlation between Gal-3 and CHA2DS2-VASc score,HAS-BLED score were significantly positive in HF-AF patients（r>0,P<0.05）.4 The optimal cut-off value of Gal-3 for diagnosis of HF was 17.71ng/mL,and the area under the ROC curve was 0.832,with sensitivity of 69.2%and speci-ficity of 85.7%.Cut-off value for diagnosing HF-AF was 18.31ng/mL,the AUC was0.867,the sensitivity was 73.3%,and the specificity was 100%.In HFpEF patients,the sensitivity（60.5%）of Gal-3 in differential diagnosis of AF is lower than BNP（86.1%）,specificity（79%）higher than BNP（60.5%）[Best cut-off values were Gal-321.16 ng/mL,BNP 149.5 pg/mL].5 After removing the influence of other confounding factors,multivariate cox regression analysis showed that plasma Gal-3≥17.71 ng/mL was a risk factor for re-admission/all-cause death in patients with HF followed up for 6 months:the 6-month event-free survival rate of HF patients with baseline plasma Gal-3≥17.71ng/mL was 74.07%,and the one of Gal-3<17.71 ng/mL was 91.67%（RR=2.783,95%CI=1.074⁷.211,P=0.035）;admission echocardio-graphic LVEF（RR=0.045,95%CI=0.005⁰.435,P=0.007）was a protective factor.Cardiomyopathy（RR=3.089,95%CI=1.29⁷.393,P=0.011）and LA-D（RR=1.033,95%CI=1.003¹.063,P=0.029）were risk factors for adverse cardiac events in HF-AF patients with a follow-up of 6 months after admission.Conclusions 1 NYHA,BNP and LVEF can be used as traditional indicators for risk stratification and severity assessment of HF,but the application value is not satisfying in HF-AF patients.2Gal-3 is a stable biomarker,and the circulating concentration is not affected by factors such as age,gender,smoking and drinking history,anemia,body mass index and the like.3 Plasma Gal-3 can diagnosis HF/HF-AF with high sensitivity and specificity;in HFpEF patients,Gal-3 can distinguish AF from SR with a higher specificity than BNP.Gal-3 can reflect severity and risk stratification of HF/HF-AF patients.4.Multivariate cox regression analysis showed that baseline plasma Gal-3concentration and echocardiographic left ventricular ejection fraction were the prognostic factors for patients with heart failure at 6 months of admission（P<0.05）;cardiomyopathy and left atrial diameter could affect the prognosis of patients with HF-AF（P<0.05）.Plasma Gal-3 has certain diagnostic,auxiliary diagnostic and severity assessment value for patients with HF/HF-AF,and has prognostic value for HF patients.