Usefulness of Combining Galectin-3 and BIVA Assessments in Predicting Short- and Long-Term Events in Patients Admitted for Acute Heart Failure

Abstract

Introduction. Acute heart failure (AHF) is associated with a higher risk for the occurrence of rehospitalization and death. Galectin-3 (GAL3) is elevated in AHF patients and is an indicator in predicting short-term mortality. The total body water using bioimpedance vector analysis (BIVA) is able to identify mortality within AHF patients. The aim of this study was to evaluate the short- and long-term predictive value of GAL3, BIVA, and the combination of both in AHF patients in Emergency Department (ED). Methods. 205 ED patients with AHF were evaluated by testing for B type natriuretic peptide (BNP) and GAL3. The primary endpoint was death and rehospitalization at 30, 60, 90, and 180 days and 12 and 18 months. AHF patients were evaluated at the moment of ED arrival with clinical judgment and GAL3 and BIVA measurement. Results. GAL3 level was significantly higher in patients >71 years old, and with eGFR < 30 cc/min. The area under the curve (AUC) of GAL3 + BIVA, GAL3 and BIVA for death and rehospitalization both when considered in total and when considered serially for the follow-up period showed that the combination has a better prognostic value. Kaplan-Meier survival curve for GAL3 values >17.8 ng/mL shows significant survival difference. At multivariate Cox regression analysis GAL3 is an independent variable to predict death + rehospitalization with a value of 32.24 ng/mL at 30 days (P < 0.005). Conclusion. In patients admitted for AHF an early assessment of GAL3 and BIVA seems to be useful in identifying patients at high risk for death and rehospitalization at short and long term. Combining the biomarker and the device could be of great utility since they monitor the severity of two pathophysiological different mechanisms: heart fibrosis and fluid overload.

Usefulness of combining admission brain natriuretic peptide (BNP) plus hospital discharge bioelectrical impedance vector analysis (BIVA) in predicting 90 days cardiovascular mortality in patients with acute heart failure

“…In detecting congestion and latent fluid overload, BIVA has greater diagnostic sensitivity than other techniques (including fluid balance), and it also shows an emerging role for its prognostic value [16]. Previous data from our group demonstrates that the reduction of congestion detected by BIVA, during AHF patients hospitalization, is linked with an improvement in patients' outcome [17,20,23].…”

The Prognostic Value of Plasma Galectin-3 in Chronic Heart Failure Patients Is Maintained when Treated with Mineralocorticoid Receptor Antagonists

“…Moreover, Gal-3 changes in patients were shown to be a strong prognostic indicator [ 29 ]. In addition, Gal-3 levels have a potential role in early detection of myocardial structural and functional alterations [ 30 ] and risk stratification in HF [ 31 , 32 ].…”

The Ultrasonic Microsurgical Anatomical Comparative Study of the CHD Fetuses and Their Clinical Significance

“…It was reported that the 64-detector computed tomography could provide a good diagnostic performance in congenital heart disease [ 31 ], which depends on the understanding of normal fetal cardiac anatomic structure; meanwhile, some new studies demonstrated that the identification and characterization of the cellular and molecular pathways involved in the differentiation and morphogenesis of specific cell types of the developing heart were crucial to understanding the process of cardiac development and the pathology associated with human congenital heart disease, and they found that the CHD5 (congenital heart disease 5 protein) was essential for CASZ1 (cardiac transcription factor CASTOR) function and that the CHD5-CASZ1 interaction was necessary for cardiac morphogenesis and numerous signaling pathways were critical for normal valve development which could be reexpressed in diseased valves [ 32 – 35 ]. The increased level of PTX3 is also an independent predictor of combined end point of left ventricle dysfunction or mortality at one year; combining the biomarker and the device could be of great utility since they monitor the severity of two pathophysiological different mechanisms: heart fibrosis and fluid overload [ 36 ]. However, the data of fetal heart gross anatomy is rare.…”