The prognostic role of galectin-3 and endothelial function in patients with heart failure

BACKGROUND: Heart failure (HF) is nowadays classified as HF with reduced ejection fraction (HFrEF),HF with mildly reduced EF (HFmrEF), and HF with preserved EF (HFpEF). Endothelial dysfunction(assessed by flow-mediated dilatation [FMD]), increased arterial stiffness (assessed by carotid-femoralpulse-wave velocity [PWV]), and galectin-3, a biomarker of myocardial fibrosis, have been linked tomajor adverse cardiovascular events (MACE) in patients with ischemic HF. METHODS: In this study we prospectively enrolled 340 patients with stable ischemic HF. We assessedthe brachial artery FMD, carotid-femoral PWV, and galectin-3 levels, and patients were followed up forMACE according to HF group. RESULTS: Interestingly, the FMD values exhibited a stepwise improvement according to left ventricularejection fraction (LVEF) (HFrEF: 4.74 ± 2.35% vs. HFmrEF: 4.97 ± 2.81% vs. HFpEF: 5.94 ±± 3.46%, p = 0.01), which remained significant after the evaluation of possible confounders includingage, sex, cardiovascular risk factors, and number of significantly stenosed epicardial coronary arteries(b coefficient: 0.990, 95% confidence interval: 0.166–1.814, p = 0.019). Single-vessel coronary arterydisease was more frequent in the group of HFpEF (HFrEF: 56% vs. HFmrEF: 64% vs. HFpEF: 73%,p = 0.049). PWV did not display any association with LVEF. Patients who presented MACE exhibitedworse FMD values (4.51 ± 2.35% vs. 5.32 ± 2.67%, p = 0.02), and the highest tertile of galectin-3 waslinked to more MACEs (36% vs. 5.9%, p = 0.01). CONCLUSIONS: Flow-mediated dilatation displayed a linear improvement with LVEF in patients withischemic HF. Deteriorated values are associated with MACE. Higher levels of galectin-3 might be usedfor risk stratification of patients with ischemic HF