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Prognostic value of galectin-3 in adults with congenital heart disease
Vivan J M Baggen1,2, Annemien E van den Bosch1, Jannet A Eindhoven1
1Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Insights
Galectin-3 shows significant associations with cardiovascular events in adult congenital heart disease (ACHD) patients. However, its added value is limited when combined with NT-proBNP, a common risk marker.
Area of Science:
- Cardiology
- Biomarker Research
- Adult Congenital Heart Disease (ACHD)
Background:
- Galectin-3 is an emerging biomarker for heart failure risk stratification.
- Adult Congenital Heart Disease (ACHD) patients have unique long-term cardiovascular risks.
- Investigating novel biomarkers like galectin-3 is crucial for ACHD management.
Purpose of the Study:
- To investigate galectin-3 release in ACHD patients.
- To determine the association between galectin-3 and cardiovascular events in ACHD.
- To assess the added value of galectin-3 beyond established risk markers.
Main Methods:
- Prospective cohort study of 602 ACHD patients.
- Galectin-3 serum levels measured by batch analysis.
- Multivariable Cox models used to analyze associations with primary endpoints (mortality, heart failure, hospitalization, etc.).
Main Results:
- Galectin-3 levels correlated with age, NYHA class, cardiac dysfunction, and NT-proBNP.
- Elevated galectin-3 was observed in 7% of ACHD patients.
- While initially associated with adverse events, this link was negated after adjusting for NT-proBNP.
Conclusions:
- Galectin-3 is linked to functional capacity, cardiac function, and adverse events in ACHD.
- The incremental value of galectin-3 over NT-proBNP for risk prediction in ACHD appears limited.
- Further research may clarify galectin-3's role in specific ACHD subpopulations.
Objective:
Galectin-3 is an emerging biomarker for risk stratification in patients with heart failure. This study aims to investigate the release of galectin-3 and its association with cardiovascular events in patients with adult congenital heart disease (ACHD).
Methods:
In this prospective cohort study, 602 consecutive patients with ACHD who routinely visited the outpatient clinic were enrolled between 2011 and 2013. Galectin-3 was measured in thaw serum by batch analysis. The association between galectin-3 and a primary endpoint of all-cause mortality, heart failure, hospitalisation, arrhythmia, thromboembolic events and cardiac interventions was investigated using multivariable Cox models. Reference values and reproducibility were established by duplicate galectin-3 measurements in 143 healthy controls.
Results:
Galectin-3 was measured in 591 (98%) patients (median age 33 (25-41) years, 58% male, 90% New York Heart Association (NYHA) class I). Median galectin-3 was 12.7 (range 4.2-45.7) ng/mL and was elevated in 7% of patients. Galectin-3 positively correlated with age, cardiac medication use, NYHA class, loss of sinus rhythm, cardiac dysfunction and N-terminal pro-B-type natriuretic peptide (NT-proBNP). During a median follow-up of 4.4 (IQR 3.9-4.8) years, the primary endpoint occurred in 195 patients (33%). Galectin-3 was significantly associated with the primary endpoint in the univariable analysis (HR per twofold higher value 2.05; 95% CI 1.44 to 2.93, p<0.001). This association was negated after adjustment for NT-proBNP (HR 1.04; 95% CI 0.72 to 1.49, p=0.848).
Conclusions:
Galectin-3 is significantly associated with functional capacity, cardiac function and adverse cardiovascular events in patients with ACHD. Nevertheless, the additive value of galectin-3 to a more conventional risk marker such as NT-proBNP seems to be limited.
