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Predictors of Total Mortality and Serious Arrhythmic Events in Non-Ischemic Heart Failure Patients: The Role of
Adriano Nunes Kochi1,2, Mauricio Pimentel1,2, Michael Andrades1,2
1Hospital de Clinicas de Porto Alegre, Porto Alegre, RS - Brasil.
Insights
In heart failure (HF) patients without ischemic causes, high galectin-3 levels did not predict major arrhythmic events but were linked to overall mortality. Identifying patients without risk factors indicates an excellent prognosis.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Research
Background:
- Risk stratification in non-ischemic heart failure (HF) presents clinical challenges.
- Galectin-3, a serum fibrosis marker, may aid in prognostication for HF patients.
Purpose of the Study:
- To investigate galectin-3 as a predictive marker for major arrhythmic events and overall mortality in non-ischemic HF.
- To identify key predictors for adverse outcomes in this patient population.
Main Methods:
- Prospective cohort study of 148 non-ischemic HF patients.
- Baseline clinical and laboratory assessments, including serum galectin-3 levels.
- Primary outcome: major arrhythmic events; Secondary outcome: all-cause mortality.
Main Results:
- Elevated galectin-3 (>22.5 ng/mL) did not predict major arrhythmic events (p=0.152).
- Predictors of major arrhythmic events included LVEDD > 73mm, exercise periodic breathing (EPB), and NSVT > 8 beats.
- Galectin-3 > 22.5 ng/mL, LVEDD > 73mm, EPB, and NSVT > 8 beats predicted all-cause mortality (p<0.007 for all).
Conclusions:
- In non-ischemic HF, galectin-3 did not predict major arrhythmic events but was associated with total mortality.
- The absence of identified risk predictors identified a subgroup of HF patients with a favorable prognosis.
Background:
Risk stratification remains clinically challenging in patients with heart failure (HF) of non-ischemic etiology. Galectin-3 is a serum marker of fibrosis that might help in prognostication.
Objective:
To determine the role of galectin-3 as a predictor of major arrhythmic events and overall mortality.
Methods:
We conducted a prospective cohort study that enrolled 148 non-ischemic HF patients. All patients underwent a comprehensive baseline clinical and laboratory assessment, including levels of serum galectin-3. The primary outcome was the occurrence of arrhythmic syncope, appropriate implantable cardioverter defibrillator therapy, sustained ventricular tachycardia, or sudden cardiac death. The secondary outcome was all-cause death. For all statistical tests, a two-tailed p-value<0.05 was considered significant.
Results:
In a median follow-up of 941 days, the primary and secondary outcomes occurred in 26 (17.5%) and 30 (20%) patients, respectively. Serum galectin-3>22.5 ng/mL (highest quartile) did not predict serious arrhythmic events (HR: 1.98, p=0.152). Independent predictors of the primary outcome were left ventricular end-diastolic diameter (LVEDD)>73mm (HR: 3.70, p=0.001), exercise periodic breathing (EPB) on cardiopulmonary exercise testing (HR: 2.67, p=0.01), and non-sustained ventricular tachycardia (NSVT)>8 beats on Holter monitoring (HR: 3.47, p=0.027). Predictors of all-cause death were galectin-3>22.5 ng/mL (HR: 3.69, p=0.001), LVEDD>73mm (HR: 3.35, p=0.003), EPB (HR: 3.06, p=0.006), and NSVT>8 beats (HR: 3.95, p=0.007). The absence of all risk predictors was associated with a 91.1% negative predictive value for the primary outcome and 96.6% for total mortality.
Conclusions:
In non-ischemic HF patients, elevated galectin-3 levels did not predict major arrhythmic events but were associated with total mortality. Absence of risk predictors revealed a prevalent subgroup of HF patients with an excellent prognosis.
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