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Galectin‐3 in patients with heart failure with preserved ejection fraction: results from the Aldo‐ DHF trial
Author(s) -
Edelmann Frank,
Holzendorf Volker,
Wachter Rolf,
Nolte Kathleen,
Schmidt Albrecht G.,
KraigherKrainer Elisabeth,
Duvinage André,
Unkelbach Ines,
Düngen HansDirk,
Tschöpe Carsten,
HerrmannLingen Christoph,
Halle Martin,
Hasenfuss Gerd,
Gelbrich Götz,
Stough Wendy Gattis,
Pieske Burkert M.
Publication year - 2015
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.203
Subject(s) - spironolactone , medicine , heart failure , ejection fraction , cardiology , galectin 3 , heart failure with preserved ejection fraction , hazard ratio , fibrosis , aldosterone , body mass index , placebo , mineralocorticoid receptor , natriuretic peptide , cardiac fibrosis , confidence interval , pathology , alternative medicine
Aims Galectin‐3 is a marker of myocardial fibrosis and mediates aldosterone‐induced cardiovascular inflammation and fibrosis. Characteristics of galectin‐3 and its response to spironolactone have not been evaluated in heart failure with preserved ejection fraction ( HFpEF ). The aim of this study was to determine the association between galectin‐3 levels and patient characteristics in HFpEF ; to evaluate the interaction between spironolactone and galectin‐3 levels; and to assess the association between galectin‐3 and clinical outcomes. Methods and results Aldo‐ DHF investigated spironolactone 25 mg once daily vs. placebo for 12 months in patients with NYHA class II–III , LVEF ≥50%, grade ≥ I diastolic dysfunction, and peakVO 2 ≤ 25 mL /kg/min. Galectin‐3 levels were obtained at baseline, and at 6 and 12 months. The association between baseline galectin‐3, change in galectin‐3, and all‐cause death or hospitalization was evaluated, and the interaction between galectin‐3 and treatment was assessed. Median baseline galectin‐3 was 12.1 ng/ mL . After multivariable adjustment, baseline galectin‐3 inversely correlated with peak VO 2 ( P = 0.021) , 6 min walk distance ( P = 0.002), and Short Form 36 ( SF ‐36) physical functioning ( P = 0.001), and directly correlated with NYHA class ( P = 0.007). Baseline NT‐proBNP correlated with E/e' velocity ratio ( P ≤ 0.001), left atrial volume index ( P < 0.001), and LV mass index ( P = 0.009). Increasing galectin‐3 at 6 or 12 months was associated with all‐cause death or hospitalization independent of treatment arm [hazard ratio ( HR ) 3.319, 95% confidence interval ( CI ) 1.214–9.07, P = 0.019] and NT‐proBNP ( HR 3.127, 95% CI 1.144–8.549, P = 0.026). Spironolactone did not influence galectin‐3 levels. Conclusion Galectin‐3 levels are modestly elevated in patients with stable HFpEF and relate to functional performance and quality of life. Increasing galectin‐3 was associated with worse outcome, independent of treatment or NT‐proBNP .