Galectin-3 and soluble ST2 as complementary tools to cardiac MRI for sudden cardiac death risk stratification in heart failure: A review

Abstract

Heart failure (HF) is recognized as one of the leading causes of morbidity and mortality worldwide. Every year about 500,000 new cases of HF are diagnosed in the United States. The predominant etiology of death in HF patients include sudden cardiac death (SCD) and pump failure. Prediction of mode of death may help in devising management decisions. In patients with HF, the presence of myocardial fibrosis has been a known risk factor for SCD and thus it could be used as a criterion in risk stratification for SCD. However, the underlying pathophysiology of SCD is uncertain and controversial, which makes it necessary to develop newer tools to enhance SCD risk stratification. The newer tools should be innovative enough either to complement or to replace the currently available tools. In this scoping review, we highlighted the utilization of novel biomarkers galectin-3 (gal-3) and soluble ST2 (sST2) and discussed that how they might complement currently available tools such as, cardiac MRI (CMR) for SCD risk stratification in HF patients.

Well-Known and Novel Serum Biomarkers for Risk Stratification of Patients with Non-ischemic Dilated Cardiomyopathy

“…An important advantage of ST2 is that its value does not vary with age, sex, body mass index, renal function or heart failure history, as in the case of BNP, NT-proBNP or hs-troponin [ 41 ]. Several studies have demonstrated the prognostic utility of soluble ST2 in patients with acutely decompensated heart failure, high levels of sST2 being associated with an increased risk of heart failure complications, such as arrhythmia, pump failure or death, independent of other cardiac biomarkers [ 42 , 43 , 44 , 45 ]. Additionally, the prognostic value of sST2 in patients with mild-to-moderate heart failure with LV systolic dysfunction was investigated by Pascual-Figal et al Their results suggest that elevated sST2 values tend to predict the risk of sudden cardiac death in patients with heart failure and may also improve prognostic strategies in heart failure management [ 46 ].…”

Simple Predictors for Cardiac Fibrosis in Patients with Type 2 Diabetes Mellitus: The Role of Circulating Biomarkers and Pulse Wave Velocity

“…Previous studies have identified higher circulating galectin-3 levels predicting the onset of HFpEF [ 32 , 33 ]. In addition to LGE-MRI, galectin-3 seems to play an important role in the sudden death risk stratification of heart failure patients [ 34 ]. Our study confirms the predictive value of galectin-3 in the diagnosis of cardiac fibrosis.…”

Fibrosis, the Bad Actor in Cardiorenal Syndromes: Mechanisms Involved

“…In addition to the impaired cardiac contractility, fibrosis also interferes with the normal electrical signals within the heart, which predisposes to arrhythmias and fibrillation [ 118 , 119 ]. Overall, fibrosis has thus been proposed as a risk factor in HF as it predisposes to ventricular systolic and diastolic dysfunction [ 120 , 121 , 122 ], cardiomyocyte hypertrophy [ 122 , 123 , 124 ] and sudden cardiac death [ 125 , 126 ], thereby increasing mortality [ 127 , 128 ].…”