Predictive value of serum galectin-3 levels in patients with acute heart failure with preserved ejection fraction
Predictive value of serum galectin-3 levels in patients with acute heart failure with preserved ejection fraction
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DOI：
10.1016/j.ijcard.2013.08.081
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发表时间：
2013-11-05
影响因子：
3.5
通讯作者：
Ignacio Perez-Calvo, Juan
中科院分区：
文献类型：
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作者：
Javier Carrasco-Sanchez, Francisco;Aramburu-Bodas, Oscar;Ignacio Perez-Calvo, Juan
目的：本研究旨在确定半乳糖苷结合凝集素Gal3 （β -半乳糖苷结合凝集素）是否有助于预测心力衰竭（HF）和左心室射血分数（LVEF）患者的预后。方法和结果：我们在419例HF和LVEF超过45%的患者入院时测量了Gal3、尿素、肌酐和利钠肽。主要终点是一年随访时的全因死亡率和/或再入院。建立Gal3和经典危险因素的多变量Cox比例风险模型。我们还评估了在添加Gal3水平后，根据不同评分类别对患者的重新分类。共有219例患者合并不良事件，129例患者在随访期间死亡。Kaplan-Meir生存曲线显示，根据Gal3的四分位数，主要终点和全因死亡率显著增加（log rank, P < 0.001）。在调整年龄、肾小球滤过率、贫血、糖尿病、血清钠、脑利钠肽水平、NYHA等级和尿素等因素后，血清Gal3水平高于中位数（13.8 ng/ml）是主要终点风险的显著预测因子（风险比1.43,95% CI 1.07-1.91 P = 0.015）。添加Gal3后，重分类指数显著提高（9.5%,P < 0.001），综合判别指数为0.022 （P = 0.001）。使用Gal3的临床预测模型将c统计量从0.711提高到0.731（差异为0.020,P - 0.001）。结论：血清Gal3是心衰和LVEF患者不良结局的一个强大且独立的预测因子。我们还展示了将新的生物标志物添加到模型中的改进。2013爱思唯尔爱尔兰有限公司版权所有。
Aims: This study was conducted to determine whether galectin-3 (Gal3), a beta-galactoside-binding lectin, has usefulness to predict outcomes in patients with heart failure (HF) and preserved left ventricular ejection fraction (LVEF).Methods and results: We measured Gal3, urea, creatinine and natriuretic peptides on admission in 419 selected patients with HF and LVEF over 45%. The primary endpoint was all-cause mortality and/or readmission at one-year follow-up. Multivariable Cox proportional hazards models were generated for Gal3 and classical risk factors. We also evaluated the reclassification of patients on the basis of the different score category after adding Gal3 levels.A total of 219 patients had combined adverse events, and 129 patients died during the follow-up. Kaplan-Meir survival curve showed significantly increased primary endpoint and all-cause mortality according to quartiles of Gal3 (log rank, P < 0.001). Serum Gal3 levels above median (13.8 ng/ml) was a significant predictor of primary endpoint risk after adjustment for age, estimated glomerular filtration rate, anemia, diabetes, serum sodium, brain natriuretic peptide levels, NYHA class and urea, respectively (hazard ratio 1.43, 95% CI 1.07-1.91 P = 0.015). The reclassification index increased significantly after addition of Gal3 (9.5%, P < 0.001) and the integrated discrimination index was 0.022, (P = 0.001). The clinical prediction model with Gal3 increased the c-statistic from 0.711 to 0.731 (difference of 0.020, P - 0.001).Conclusions: Serum Gal3 is a strong and independent predictor of unfavorable outcomes in patients with HF and preserved LVEF. We also demonstrated the improvement of adding the new biomarker to the model. (C) 2013 Elsevier Ireland Ltd. All rights reserved.