Objective Galectin-3 is an emerging biomarker for risk stratification in patients with heart failure. This study aims to investigate the release of galectin-3 and its association with cardiovascular events in patients with adult congenital heart disease (ACHD).
Methods In this prospective cohort study, 602 consecutive patients with ACHD who routinely visited the outpatient clinic were enrolled between 2011 and 2013. Galectin-3 was measured in thaw serum by batch analysis. The association between galectin-3 and a primary endpoint of all-cause mortality, heart failure, hospitalisation, arrhythmia, thromboembolic events and cardiac interventions was investigated using multivariable Cox models. Reference values and reproducibility were established by duplicate galectin-3 measurements in 143 healthy controls.
Results Galectin-3 was measured in 591 (98%) patients (median age 33 (25–41) years, 58% male, 90% New York Heart Association (NYHA) class I). Median galectin-3 was 12.7 (range 4.2–45.7) ng/mL and was elevated in 7% of patients. Galectin-3 positively correlated with age, cardiac medication use, NYHA class, loss of sinus rhythm, cardiac dysfunction and N-terminal pro-B-type natriuretic peptide (NT-proBNP). During a median follow-up of 4.4 (IQR 3.9–4.8) years, the primary endpoint occurred in 195 patients (33%). Galectin-3 was significantly associated with the primary endpoint in the univariable analysis (HR per twofold higher value 2.05; 95% CI 1.44 to 2.93, p<0.001). This association was negated after adjustment for NT-proBNP (HR 1.04; 95% CI 0.72 to 1.49, p=0.848).
Conclusions Galectin-3 is significantly associated with functional capacity, cardiac function and adverse cardiovascular events in patients with ACHD. Nevertheless, the additive value of galectin-3 to a more conventional risk marker such as NT-proBNP seems to be limited.
- Congenital Heart Disease
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Contributors Conception and design of the study was performed by JWR-H and EB; all authors performed the analysis and interpretation of the data. In addition, data acquisition was performed by VJMB, JAE, MEM, MW, JAAEC, EB and JWR-H. Funding of the study was arranged by VJMB, JWR-H and EB. Drafting of the manuscript was performed by VJMB and JWR-H, after which it was critically revised for important intellectual content by AEvdB, JAE, MEM, MW, JAAEC and EB. All authors approved the final version of the manuscript submitted and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding This work was supported by a grant from the Dutch Heart Foundation, The Hague, The Netherlands (grant number 2015T029) to VJMB.
Competing interests None declared.
Ethics approval Erasmus MC medical ethics committee.
Provenance and peer review Not commissioned; externally peer reviewed.