The Observation Between Galectin-3and Coronary Heart Disease With Heart Failure

Background Heart failure(HF)is the end stage of cardiovascular diseases.In severe patients, the annual mortality is above50%.HF with normal ejection fraction (HFNEF)constitutes nearly half of all HF patients and is associated with high morbidity and mortality,which is similar with heart failure with reduced ejection fraction(HFREF).Galectin-3(Gal-3)is a useful biomarker which is involved in the pathological physiology process of HF. However, the predictive value of plasma galectin-3levels in patients with coronary heart disease(CHD)and HF has not been fully elucidated.Objectives1. To compare plasma Gal-3level in CHD patients with or without HF.2. To compare the clinical characteristic and prognosis among consecutively hospitalized patients with HFNEF and HFREF.3. To explore the predictive value of Gal-3in CHD patients with HF.Methods261patients with CHD were prospectively studied.In them,150cases were hospitalized for HF, which including102cases with HFNEF and48cases with HFREF,and111patients had no HF. They were followed for12months.The primary end-point was cardiac death and HF re-hospitalization.All the data were analyzed by using the SPSS17.0software.Results for baseline characteristics were presented as mean±SD,using t test for comparing two groups,chi-square tests for categorical data and the Wilcoxon rank-sum test for continuous data. The association between Gal-3level and the instantaneous relative risk of death from any cause was analyzed using a Cox proportional hazards regression analysis.P values<0.05denote statistically significant differences.Results1.Compared with non-HF patients,plasma gal-3levels in HF patients were higher(P=0.000).Receiver operating characteristic(ROC)analysis for diagnosis of HF showed that Gal-3had the greatest area under the curve(AUC)of0.756(p=0.000),with an optimal cutoff of10.8ng/ml yielding a sensitivity of81.7%and a specificity of61.7%.2.In all patients with HF,32%of them had HFNEF.HFNEF patients were more often seen in femal patients, had a higher prevalence of hypertention,atrial fibrillation, valvular heart disease, anemia(P=0.000,P=0.045,P=0.001,P=0.024,P=0.004),and a higher level of ages,BMI,left ventricular mass index (P=0.047,P=0.023,P=0.015),and a lower level of heart rate,NYHA functional class,concentrations of BNP,left ventricular end diastolic diameter(P=0.000,P=0.018,P=0.000,P=0.003). In a period of12months follow-up,the rate of deaths and rehospitalizations in HFNEF and HFREF were14.6%vsl3.7%,22.9%vs25.5%(P=1.000,P=0.84).3. In CHD with HF patients, along with the plasma Galectin-3concentration increases, the incidence of cardiovascular events and NYHA functional class were gradually increased. ROC analysis mortality prediction showed that Gal-3predicted the primary outcome with an optimal cutoff of17.775ng/ml yielding a sensitivity of97.3%and a specificity of77.6%;Gal-3an AUC of0.899(p=0.000) and BNP had an AUC of0.633(p=0.022).The results of a multivariate analysis using a Cox proportional hazards model was that Gal-3was an independent prognostic predictor in HFNEFpatients,and BNP was an independent prognostic predictor in HFREF patients.especially for HFNEF patients.Galectin-3had an AUC of0.931(p=0.000) in HFNEF and an AUC of0.882(p=0.000) in HFREF.Conclusion1.Plasma Gal-3levels above10.8ng/ml contributes to the diagnosis of heart failure in CHD patients.2.Clinical features of HFNEF and HFREF are different and their prognosisare similar.3.In CHD patients with HF, along with the plasma Gal-3concentration increases, the incidence of cardiovascular events and NYHA functional class are gradually increased; plasma Gal-3levels above17.775ng/ml contributes to the poor outcome.The prognostic value of Gal-3level in HF and CHD patients is higher than that of BNP,especially for HFNEF.