Additional value of Galectin-3 to BNP in acute heart failure patients with preserved ejection fraction

Background: Almost half of patients with acute heart failure have preserved ejection fraction (HFpEF). HFpEF is a diagnostic challenge using traditional investigation tools; Galectin-3 (Gal-3) is an emerging biomarker useful in individuals at risk for HF. The aim of our study is to analyse the relation and prognostic value of Gal-3, BNP and renal dysfunction in patients with HFpEF compared to patients with reduced ejection fraction (HFrEF). Methods: We enrolled 98 patients with acute heart failure (AHF) and measured Gal-3, BNP, and estimated glomerular filtration rate (eGFR) within 12 h of hospital admission. On the basis of echocardiographic findings we divided our sample into two groups: patients with HFrHF (ejection fraction < 50%) or HFpEF (ejection fraction > 50%). Patients were followed up at 6 months. Results: No differences in Gal-3 levels were found in the two subgroups (HFrEF: 19.5 ± 5.1 ng/mL; HFpEF: 20.5 ± 8.7, p = 0.56). Gal-3 was inversely related to renal dysfunction (LogGal-3 vs eGFR: r = -. 0.30, p = 0.01) but did not correlate with LogBNP levels (r = 0.07, p = 0.55). Gal-3 was associated with more advanced diastolic dysfunction in HFpEF (p = 0.009). In addition LogGal-3 was related to diastolic LV stiffness (all patients: r = 0.45, p < 0.001; HFpEF: r = 0.64, p < 0.001). Cox regression analysis showed that LogGal-3 > 1.30 was related to poor outcome independently from renal dysfunction and other risk factors only in HFpEF (univariate HR 23.98 [3.03-89.45]; p < 0.001). Adjusted for renal dysfunction (HR 16.32 [1.98-34.09]; p = 0.009). Conclusions: Gal-3 is not able to distinguish between HFrEF and HFpEF patients. However it is related to diastolic dysfunction severity and LV stiffness in HFpEF. Gal-3 demonstrates a prognostic role independently from renal dysfunction in subjects with HFpEF.