2015


To access this material please log in or register

Register Authorize
2015/№5

Prognostic significance of galectin-3 level in acute coronary syndrome in the setting of real clinical practice

Malinova L. I.1, Podbolotov R. A.1, Denisova T. P.2, Dovgalevsky P. Ya.1
1 – Federal State Budgetary Institution, “Saratov Research Institute of Cardiology” at the RF Ministry of Health Care, Chernyshevskogo 141, Saratov 410028
2 – State Budgetary Educational Institution of Higher Professional Education, “V. I. Razumovsky Saratov State Medical University” at the RF Ministry of Health Care, Bolshaya Kazachjya 112, Saratov 410012

Keywords: acute coronary syndrome, CHF, galectin-3, prognosis, personalization of drug therapy

DOI: 10.18087 / rhj.2015.5.2103

Background. An option for optimizing the management of patients with ACS is therapy personalization based on measurement of blood markers. Aim. To evaluate clinical and predictive significance of galectin-3 (Gal-3) in ACS patients under the conditions of real clinical practice. Materials and methods. This prospective, stratified study included patients admitted to a cardiac resuscitation unit for ACS (n=74). Observation period was 12 months. Primary endpoint was a composite endpoint (CEP) including cardiovascular death and rehospitalization. Gal-3 levels were measured in EDTA plasma using the enzyme immunoassay. Results. For the observation period, 21 (28.4 %) patients reached the primary CEP; in most cases (75 %), cardiovascular death occurred within 30 days of ACS manifestation. Plasma levels of Gal-3 exceeding 17.8 ng / ml were associated with a significant increase in the risk of reaching the CET (HR, 2.06; CI, 157; 2.79). The risk of fatal outcome was practically four times higher for patients with plasma Gal-3 level above the threshold level of 17.8 ng / ml than for other patients (HR, 3.87; CI, 3.38; 4.43). Early  treatment of ACS patients with Gal-3 levels exceeding 17.8 ng / ml with higher ACEI doses (>70 % of target dose) reduced the risk for unfavorable cardiovascular events (HR, 1.87; CI, –2.16; –1.54). Conclusion. In patients with ACS, plasma levels of Gal-3 above 17.8 ng / ml are associated with higher risk for fatal outcome and rehospitalization due to aggravation of cardiac symptoms. Early treatment with high ACEI doses results in reduced risk for unfavorable cardiovascular events in ACS patients with high levels of Gal-3.
  1. van Diepen S, Bakal JA, Lin M, Kaul P, McAlister FA, Ezekowitz JA. Variation in critical care unit admission rates and outcomes for patients with acute coronary syndromes or heart failure among high- and low-volume cardiac hospitals. J Am Heart Assoc. 2015 Feb 27;4 (3):e001708.
  2. Southern DA, Ngo J, Martin BJ, Garlbraith PD, Knudtson ML, Ghali WA et al. Characterizing types of readmission after acute coronary syndrome hospitalization: implications for quality reporting. J Am Heart Assoc. 2014 Sep 18;3 (5):e001046.
  3. Felker GM, Hasselblad V, Hernandez AF, O’Connor CM. Biomarker-guided therapy in chronic heart failure: a meta-ana­lysis of randomized controlled trials. Am Heart J. 2009 Sep;158 (3):422–30.
  4. Агеев Ф. Т., Азизова А. Г. Галектин-3 – новый биохимический маркер сердечной недостаточности. Журнал Сердечная Недостаточность. 2011;12 (2):108–14.
  5. de Boer RA, Yu L, van Veldhuisen DJ. Galectin-3 in cardiac remo­deling and heart failure. Curr Heart Fail Rep. 2010 Mar;7 (1):1–8.
  6. de Boer RA, Lok DJ, Jaarsma T, van der Meer P, Voors AA, Hillege HL, van Veldhuisen DJ. Predictive value of plasma galectin-3 le­vels in heart failure with reduced and preserved ejection fraction. Ann Med. 2011 Feb;43 (1):60–8.
  7. van der Velde AR, Gullestad L, Ueland T, Aukrust P, Guo Y, Adourian A et al. Prognostic value of changes in galectin-3 levels over time in patients with heart failure: data from CORONA and COACH. Circ Heart Fail. 2013 Mar;6 (2):219–26.
  8. Лечение острого коронарного синдрома без стойкого подъе­ма ST на ЭКГ. Российские рекомендации. Кардиоваскулярная терапия и профилактика. 2006;8 (5 Прил 1):1–31.
  9. Национальные рекомендации по диагностике и лечению больных острым инфарктом миокарда с подъемом сегмента ST ЭКГ. Кардиоваскулярная терапия и профилактика. 2007;6 (8 прил 1):1–66.
  10. Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, Borger MA et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012 Oct;33 (20):2569–619.
  11. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011 Dec;32 (23):2999–3054.
  12. Taylor J. 2012 ESC Guidelines on acute myocardial infarction (STEMI). Eur Heart J. 2012 Oct;33 (20):2501–2.
  13. Лакомкин С. В., Скворцов А. А., Горюнова Т. В., Масенко В. П., Терещенко С. Н. Галектин-3 – новый маркер диагностики и прогноза хронической сердечной недостаточности. Кардиология. 2012;52 (3):45–52.
  14. Hrynchyshyn N, Jourdain P, Desnos M, Diebold B, Funck F. Galectin-3: a new biomarker for the diagnosis, analysis and prognosis of acute and chronic heart failure. Arch Cardiovasc Dis. 2013 Oct;106 (10):541–6.
  15. de Boer RA, Voors AA, Muntendam P, van Gilst WH, van Veldhuisen DJ. Galectin-3: a novel mediator of heart failure deve­lopment and progression. Eur J Heart Fail. 2009 Sep;11 (9):811–7.
  16. Щукин Ю. В., Березин И. И., Медведева Е. А., Селезнев Е. И., Дьячков В. А., Слатова Л. Н. О значении галектина-3 как маркера и медиатора эндогенного воспаления и окислительно-нитрозилирующего стресса у больных хронической сердечной недостаточностью. Российский кардиологический журнал. 2013 (2):45–9.
  17. de Boer RA, van Veldhuisen DJ, Gansevoort RT, Muller Kobold AC, van Gilst WH, Hillege HL et al. The fibrosis marker galectin-3 and outcome in the general population. J Intern Med. 2012 Jul;272 (1):55–64.
  18. Shah RV, Chen-Tournoux AA, Picard MH, van Kimmenade RR, Januzzi JL. Galectin-3, cardiac structure and function, and long-term mortality in patients with acutely decompensated heart failure. Eur J Heart Fail. 2010 Aug;12 (8):826–32.
  19. van Kimmenade RR, Januzzi JL, Ellinor PT, Sharma UC, Bakker JA, Low AF et al. Utility of amino-terminal pro-brain natriuretic peptide, galectin-3, and apelin for the evaluation of patients with acute heart failure. J Am Coll Cardiol. 2006 Sep 19;48 (6):1217–24.
  20. De Berardinis B, Magrini L, Zampini G, Zancla B, Salerno G, Cardelli P et al. Usefulness of combining galectin-3 and BIVA assessments in predicting short- and long-term events in patients admitted for acute heart failure. Biomed Res Int. 2014;2014:983098.
  21. McCullough PA. Practical experience using galectin-3 in heart failure. Clin Chem Lab Med. 2014 Oct;52 (10):1425–31.
Malinova L. I., Podbolotov R. A., Denisova T. P., Dovgalevsky P. Ya. Prognostic significance of galectin-3 level in acute coronary syndrome in the setting of real clinical practice. Russian Heart Journal. 2015;14 (5):273–280

To access this material please log in or register

Register Authorize
Ru En