Abstract 18557: Low Galectin-3 Identifies Heart Failure Patients at Minimal Risk for Death or Rehospitalization
Introduction: Acute heart failure (AHF) patients have a very high mortality and unplanned hospital readmission rate approaching 25% within 30 days, up to 30% within 90 days. Stratification tools that predict a (very) low risk for mortality or rehospitalization would be potentially useful as such patients may be discharged early. We aimed to determine if the emerging biomarker galectin-3 could identify AHF patients at low risk for death or rehospitalization compared to BNP after discharge.
Methods: This was a substudy of the Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH). Enrollment of AHF patients occurred prior to discharge. We evaluated the relationship between percentiles of galectin-3 (and BNP) and the prediction of low risk in 592 patients.
Results: In this cohort, the median [IQR] age, BNP and left ventricular ejection fraction were 73 years [64-79], 448 pg/mL [197-911], and 30% [23-43], respectively. Overall, the median [IQR] galectin-3 level was 20 ng/mL [15-26], with a maximum of 67 ng/mL. Patients with elevated galectin-3 levels had more severe disease, reflected by higher age, worse renal function, and higher BNP. No patient died within 30, 90 or 180 days with a galectin-3 level <11.8 ng/mL (10th percentile). No patient below this value was rehospitalized during 90 days follow-up and only one patient within 180 days. In comparison, the 10% lowest BNP levels (<96 pg/mL) failed to identify patients who died (N=7) or were rehospitalized (N=8) within 180 days. Also in higher percentiles (20-50th), galectin-3 remained superior over BNP in identifying low risk patients. We created a cox-hazard regression model, and this showed that galectin-3 level <11.8 remained a significant predictor of death or rehospitalization, also after adjustment for age, sex, (log) BNP, eGFR, NYHA class and LVEF: HR (CI) 0.32 (0.15-0.70); p<0.01). On top of these predictors for outcome, galectin-3 <11.8 ng/mL added significantly to the receiver operator characteristic curve for the composite outcome of 180 day death and rehospitalization (p<0.05).
Conclusion: A galectin-3 level <11.8 ng/mL identifies discharged AHF patients without 30, 90 and 180 day mortality, and with a minimal risk for repeated HF rehospitalization.
Author Disclosures: W.C. Meijers: None. R.A. de Boer: Honoraria; Modest; Novartis, Biomerieux, Conmed. Ownership Interest; Modest; Pectacea. D.J. van Veldhuisen: None. T. Jaarsma: None. A.S. Maisel: Honoraria; Modest; Abbott, Nexus, Critical Diagnostics, Siemens, EFG. Honoraria; Significant; BG Medicine, Alere. S.D. Somma: Honoraria; Significant; BG Medicine, Alere. W.F. Peacock: Research Grant; Significant; Abbott, Alere, Banyan, Cardiorentis, Portola, Roche, The Medicine’s Company. Ownership Interest; Significant; Comprehensive Research Associates LLC, Emergencies in Medicine LLC. Consultant/Advisory Board; Modest; BG Medicine, Beckman, Boehringer-Ingelheim, Instrument Labs, Prevencio, The Medicine’s Company, ZS Pharma. Consultant/Advisory Board; Significant; Alere, Cardiorentis, Janssen.
- © 2014 by American Heart Association, Inc.