Abstract 17649: Elevated Galectin-3 Levels and Prediction of Mode of Death in Heart Failure: Insights from the HF-ACTION Study
Background: The two most common modes of death for patients with chronic heart failure (HF) are sudden cardiac death (SCD) and progressive failure of cardiac function (pump failure-PF). Prediction of mode of death may facilitate treatment decisions. Galectin-3 is a biomarker with prognostic significance in chronic HF, and has been shown to correlate with the presence of myocardial fibrosis, which may increase the risk of both SCD and PF. This study examines elevated Galectin-3 levels and mode of death in chronic HF.
Methods: HF-ACTION was a randomized controlled trial of exercise training vs. usual care in patients with chronic HF due to left ventricular (LV) systolic dysfunction. Mode of death was prospectively assessed by an independent clinical events committee (CEC). Galectin-3 was assessed at baseline in a cohort of 895 HF-ACTION subjects with stored plasma samples available. The association between Galectin-3 >17.8 ng/mL (recommended prognostic cut-point) and mode of death was assessed using Cox proportional hazards models.
Results: Elevated Galectin-3 levels were associated with higher NYHA class, but not ischemic etiology of HF or LV ejection function. SCD occurred in 44 (24%), PF in 53 (32%), other cardiovascular (CV) causes in 40 (24%), and non CV causes in 31 (19%) patients. Galectin-3 levels >17.8 ng/mL were associated with increased risk of both SCD and PF (Table). After adjustment for predictors of adverse outcomes, this association was weakened and no longer significant. Elevated Galectin-3 levels showing a trend towards increase in risk of SCD: HR, 1.91 ([95% CI, 0.89-4.06]; P = .09), but not PF: HR, 1.19 ([95% CI, 0.61-2.32]; P = .61).
Conclusions: In univariate analysis, elevated Galectin-3 levels show an association with increased risk of both SCD and PF, but this association does not persist after adjustment for other predictors. Whether biomarkers may be used for improved prediction of mode of death in HF requires further investigation.
- © 2012 by American Heart Association, Inc.