Feola Mauro, Testa Marzia, Leto Laura, Cardone Marco, Sola Mario, Rosso Gian Luca
aCardiovascular Rehabilitation-Heart Failure Unit, Ospedale SS Trinità Fossano bSchool of Geriatry, Università degli Studi Torino cLaboratory Service Ospedale Mondovì dMedical Emergency Service, ASL CN1-Cuneo, Italy.
Medicine (Baltimore). 2016 Jun;95(26):e4014. doi: 10.1097/MD.0000000000004014.
Galectin-3 demonstrated to be a robust independent marker of cardiovascular mid-term (18-month) outcome in heart failure (HF) patients. The objective of this study was to analyze the value of a predischarged determination of plasma galectin-3 alone and with plasma brain natriuretic peptide (BNP) in predicting mid-term outcome in frequent-flyers (FF) HF (≥2 hospitalization for HF/year)/dead patients discharged after an acute decompensated HF (ADHF) episode.All FF chronic HF subjects discharged alive after an ADHF were enrolled. All patients underwent a determination of BNP and galectin-3, a 6-minute walk test, and an echocardiogram within 48 hours upon hospital discharge. Death by any cause, cardiac transplantation, and worsening HF requiring readmission to hospital were considered cardiovascular events.Eighty-three patients (67 males, age 73.2 ± 8.6 years old) were analyzed (mean follow-up 11.6 ± 5.2 months; range 4-22 months). During the follow-up 38 events (45.7%) were scheduled: (13 cardiac deaths, 35 rehospitalizations for ADHF). According to medical history, in 33 patients (39.8%) a definition of FF HF patients was performed (range 2-4 hospitalization/year). HF patients who suffered an event (FF or death) demonstrated more impaired ventricular function (P = 0.037), higher plasma BNP (P = 0.005), and Gal-3 at predischarge evaluation (P = 0.027). Choosing adequate cut-off points (BNP ≥ 500 pg/mL and Gal-3 ≥ 17.6 ng/mL), the Kaplan-Meier curves depicted the powerful stratification using BNP + Gal-3 in predicting clinical course at mid-term follow-up (log rank 5.65; P = 0.017).Adding Gal-3 to BNP, a single predischarge strategy testing seemed to obtain a satisfactorily predictive value in alive HF patients discharged after an ADHF episode.
半乳糖凝集素-3被证明是心力衰竭（HF）患者心血管中期（18个月）预后的一个强有力的独立标志物。本研究的目的是分析单独测定出院前血浆半乳糖凝集素-3以及联合血浆脑钠肽（BNP）在预测频繁住院（FF）HF（每年因HF住院≥2次）/急性失代偿性HF（ADHF）发作后出院死亡患者中期预后中的价值。纳入所有ADHF后存活出院的FF慢性HF患者。所有患者在出院后48小时内进行BNP和半乳糖凝集素-3测定、6分钟步行试验及超声心动图检查。任何原因导致的死亡、心脏移植以及需要再次入院的HF恶化均被视为心血管事件。分析了83例患者（67例男性，年龄73.2±8.6岁）（平均随访11.6±5.2个月；范围4 - 22个月）。随访期间发生了38起事件（45.7%）：（13例心源性死亡，35例因ADHF再次住院）。根据病史，对33例患者（39.8%）进行了FF HF患者的定义（范围为每年2 - 4次住院）。发生事件（FF或死亡）的HF患者在出院前评估时心室功能受损更严重（P = 0.037）、血浆BNP更高（P = 0.005）以及Gal-3更高（P = 0.027）。选择合适的截断点（BNP≥500 pg/mL和Gal-3≥17.6 ng/mL），Kaplan-Meier曲线显示使用BNP + Gal-3在预测中期随访临床病程方面具有强大的分层能力（对数秩5.65；P = 0.017）。在BNP基础上加入Gal-3，单一的出院前策略检测似乎在ADHF发作后出院的存活HF患者中获得了令人满意的预测价值。
