心力衰竭门诊患者中半乳糖凝集素-3：HF-ACTION 研究结果。
Galectin-3 in ambulatory patients with heart failure: results from the HF-ACTION study.
机构信息
Duke University Medical Center, Durham, NC 27710, USA.
出版信息
Circ Heart Fail. 2012 Jan;5(1):72-8. doi: 10.1161/CIRCHEARTFAILURE.111.963637. Epub 2011 Oct 20.
BACKGROUND
Galectin-3 is a soluble ß-galactoside-binding lectin released by activated cardiac macrophages. Elevated levels of galectin-3 have been found to be associated with adverse outcomes in patients with heart failure. We evaluated the association between galectin-3 and long-term clinical outcomes in ambulatory heart failure patients enrolled in the HF-ACTION study.
METHODS AND RESULTS
HF-ACTION was a randomized, controlled trial of exercise training in patients with chronic heart failure caused by left ventricular systolic dysfunction. Galectin-3 was assessed at baseline in a cohort of 895 HF-ACTION subjects with stored plasma samples available. The association between galectin-3 and clinical outcomes was assessed using a series of Cox proportional hazards models. Higher galectin-3 levels were associated with other measures of heart failure severity, including higher New York Heart Association class, lower systolic blood pressure, higher creatinine, higher amino-terminal proB-type natriuretic peptide (NTproBNP), and lower maximal oxygen consumption. In unadjusted analysis, there was a significant association between elevated galectin-3 levels and hospitalization-free survival (unadjusted hazard ratio, 1.14 per 3-ng/mL increase in galectin-3; P<0.0001). In multivariable modeling, the prognostic impact of galectin-3 was significantly attenuated by the inclusion of other known predictors, and galectin-3 was no longer a significant predictor after the inclusion of NTproBNP.
CONCLUSIONS
Galectin-3 is elevated in ambulatory heart failure patients and is associated with poor functional capacity and other known measures of heart failure severity. In univariate analysis, galectin-3 was significantly predictive of long-term outcomes, but this association did not persist after adjustment for other predictors, especially NTproBNP.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00047437.
背景
半乳糖凝集素-3 是一种可溶的β-半乳糖苷结合凝集素，由激活的心肌巨噬细胞释放。研究发现，心力衰竭患者的半乳糖凝集素-3 水平升高与不良预后相关。我们评估了半乳糖凝集素-3 与 HF-ACTION 研究中门诊心力衰竭患者的长期临床结局之间的关系。
方法和结果
HF-ACTION 是一项针对左心室收缩功能障碍导致慢性心力衰竭患者的运动训练的随机对照试验。在有储存血浆样本的 895 名 HF-ACTION 受试者的队列中，在基线时评估了半乳糖凝集素-3。使用一系列 Cox 比例风险模型评估半乳糖凝集素-3 与临床结局之间的关系。较高的半乳糖凝集素-3 水平与其他心力衰竭严重程度的指标相关，包括纽约心脏协会（NYHA）心功能分级较高、收缩压较低、肌酐较高、氨基末端 proB 型利钠肽（NTproBNP）较高、最大耗氧量较低。在未调整分析中，升高的半乳糖凝集素-3 水平与无住院生存率之间存在显著相关性（未调整的危险比，每增加 3ng/mL 半乳糖凝集素-3 增加 1.14；P<0.0001）。在多变量模型中，纳入其他已知预测因素后，半乳糖凝集素-3 的预后影响明显减弱，纳入 NTproBNP 后，半乳糖凝集素-3 不再是显著的预测因素。
结论
在门诊心力衰竭患者中，半乳糖凝集素-3 水平升高，并与较差的功能能力和其他已知的心力衰竭严重程度指标相关。在单变量分析中，半乳糖凝集素-3 对长期结局有显著的预测作用，但在调整其他预测因素后，特别是 NTproBNP 后，这种相关性不再持续。
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