Practical experience using galectin-3 in heart failure

Abstract

Heart failure is a complex mechanical and neurohormonal syndrome where the left ventricle fails as a pump, resulting in stasis of blood in the lungs and the periphery resulting in the cardial features of effort intolerance, fatigue, and peripheral edema. As part of the neurohormonal and local mechanical strain, tissue macrophages resident in the myocardium secrete galectin-3 which is a paracrine and endocrine factor which stimulates additional macrophages, pericytes, myofibroblasts, and fibroblasts to proliferate and secrete procollagen I which is irreversibly crosslinked resulting in myocardial fibrosis. In the general population, normal plasma concentrations of galectin-3 are < 11.0 ng/mL. Galectin-3 measured in blood has been shown to: 1) identify increased risk for new onset heart failure in healthy middle-aged adults; 2) predict cardiac failure in patients after acute coronary syndromes; 3) help establish the diagnosis of heart failure with preserved ejection fraction in patients presenting with exercise intolerance; and 4) aid in the prognosis of heart failure with preserved and reduced left ventricular ejection fraction. This manuscript will present practical real case management in these applications to highlight the importance of this new in vitro diagnostic test.

Clinical Correlates and Prognostic Value of Plasma Galectin-3 Levels in Degenerative Aortic Stenosis: A Single-Center Prospective Study of Patients Referred for Invasive Treatment

“…Out of 80 subjects enrolled, 30 patients (38%)—in accordance with a previous report based on the same method of Gal-3 assay in 101 AS patients undergoing transcatheter aortic valve implantation (TAVI) [21]—had a Gal-3 level higher than the cut-off value of 17.8 ng/mL, previously proposed for risk stratification in established HF [5,11]. …”

“…The predictive ability of Gal-3 was tested by comparing Kaplan–Meier survival curves by the log-rank test with Gal-3 levels categorized according to a cut-off value of 17.8 ng/mL, previously proposed for risk stratification in patients with established HF [5,11]. Deaths from any cause were considered as outcome events.…”

“…Gal-3—produced mainly by activated macrophages, but also mast cells and pericytes—induces transformation of fibroblasts into myofibroblasts, fibroblast/myofibroblast proliferation, and collagen deposition [1,5]. In HF patients, Gal-3 levels predict progression of LV remodeling [6], hospitalization for worsening HF and death irrespective of LV ejection fraction (EF) [6,7,8,9,10,11,12].…”

Galectin-3: A Potential Biomarker of Rheumatic Diseases

“…Thus, several studies already showed that galectin-3 plays an important role in the development of different pathological conditions. Some studies proved that increased galectin-3 concentration is associated with high heart failure risk [17]. There are evidences that galectin-3 concentration increases signi cantly, both in chronic and acute heart failure, according to the progression of disease [18,19].…”

Prognostic biomarkers in acute coronary syndrome

“…Several lines of evidence convincingly suggest that the measurement of GAL-3 may be helpful in risk assessment of cardiac fibrosis and HF, both in the general population (28), and in patients with acute myocardial infarction (29).…”