The Predictive Value of Plasma Brain Natriuretic Peptide and Galectin-3 in Elderly Patients Admitted for Heart Failure

Abstract

Galectin-3 is demonstrated to be a robust independent marker of cardiovascular mid-term (18-month) outcomes in heart failure (HF) patients. The aim of this study was to analyze the value of a pre-discharged determination of galectin-3 alone and with brain natriuretic peptide (BNP) in predicting mid-term outcomes in elderly patients (>70 years old) discharged after an acute decompensated HF (ADHF) episode. Methods: all elderly (≥70 years old) HF subjects discharged alive after an ADHF were enrolled. All patients underwent a determination of BNP and galectin-3, a 6-min walking test (6MWT), and an echocardiogram within 48 h of hospital discharge. Cardiac death, cardiac transplantation, and worsening heart failure requiring readmission to hospital were considered cardiovascular events. Results: 84 patients (63 males (75%), age 77.5 ± 5.9 years old) were analyzed (mean follow-up: 16.2 ± 12.3 months). During the follow-up, 45 events (53.6%) were scheduled (18 cardiac deaths, 27 re-hospitalizations for ADHF). HF patients who suffered an event demonstrated more impaired ventricular function (p = 0.04), higher value of BNP (p = 0.02), and Gal-3 at a pre-discharge evaluation (p = 0.05). By choosing adequate cut-off points (BNP ≥ 500 pg/mL and Gal-3 ≥ 17.6 ng/mL), the Kaplan–Meier curves depicted a powerful stratification using Galectin-3 > 17.6 ng/mL alone (log-rank 13.22; p = 0.0003), and by adding BNP + Gal-3, an even better result was obtained (log-rank 17.96; p < 0.00001). Conclusion: in an elderly population, by adding Gal-3 to BNP, a single pre-discharge strategy testing seemed to obtain a satisfactorily predictive value in alive HF patients discharged after an ADHF episode.

Impact of Galectin-3 Circulating Levels on Frailty in Elderly Patients with Systolic Heart Failure

“…The role of Gal-3 as an independent predictor of outcomes in HF has not been confirmed; however, adding Gal-3 to the well-established NT-proBNP ameliorated the prediction of adverse outcomes [53], probably because the population of patients with higher Gal-3 were also the most-frail. Furthermore, Testa and colleagues [54] reported that a Gal-3 value >17.6 ng/mL added to the plasma BNP level > 500 pg/mL significantly improved the predictive mortality in elderly with chronic HF, and additionally the disability level was higher.…”

Sarcopenia and Frailty in Heart Failure: Is There a Biomarker Signature?

“…Elevated Gal-3 levels are associated with adverse outcomes such as cardiovascular disease as well as infections, liver fibrosis, and cancer [104]. Testa et al reported that adding Gal-3 to B-type natriuretic peptide (BNP) values significantly improved the predictive power for mortality in elderly patients with chronic HF, as well as higher levels of disability [105]. In addition, the inhibition of Gal-3 has been reported to prevent adverse cardiac remodeling by interfering with myocardial fibrosis in an experiment with HF mice [106].…”

Prognostic Significance of Biomarkers in Predicting in-Hospital All-Cause Mortality in Elderly Patients with Acute Myocardial Infarction

“…In contrast, studies with only older patients as participants showed much higher cut-off values as a mortality indicator [25,26]. These findings are important as some studies note that BNP loses its diagnostic power in elderly patients, but our results show that it can be a valuable biomarker for risk stratification [27,28].…”