Hospital de Clinicas de Porto Alegre, Porto Alegre, RS - Brasil.
Programa de Pós-Graduação em Ciências Cardiovasculares e Cardiologia da Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil.
Arq Bras Cardiol. 2021 Sep;117(3):531-541. doi: 10.36660/abc.20200353.
Risk stratification remains clinically challenging in patients with heart failure (HF) of non-ischemic etiology. Galectin-3 is a serum marker of fibrosis that might help in prognostication.
To determine the role of galectin-3 as a predictor of major arrhythmic events and overall mortality.
We conducted a prospective cohort study that enrolled 148 non-ischemic HF patients. All patients underwent a comprehensive baseline clinical and laboratory assessment, including levels of serum galectin-3. The primary outcome was the occurrence of arrhythmic syncope, appropriate implantable cardioverter defibrillator therapy, sustained ventricular tachycardia, or sudden cardiac death. The secondary outcome was all-cause death. For all statistical tests, a two-tailed p-value<0.05 was considered significant.
In a median follow-up of 941 days, the primary and secondary outcomes occurred in 26 (17.5%) and 30 (20%) patients, respectively. Serum galectin-3>22.5 ng/mL (highest quartile) did not predict serious arrhythmic events (HR: 1.98, p=0.152). Independent predictors of the primary outcome were left ventricular end-diastolic diameter (LVEDD)>73mm (HR: 3.70, p=0.001), exercise periodic breathing (EPB) on cardiopulmonary exercise testing (HR: 2.67, p=0.01), and non-sustained ventricular tachycardia (NSVT)>8 beats on Holter monitoring (HR: 3.47, p=0.027). Predictors of all-cause death were galectin-3>22.5 ng/mL (HR: 3.69, p=0.001), LVEDD>73mm (HR: 3.35, p=0.003), EPB (HR: 3.06, p=0.006), and NSVT>8 beats (HR: 3.95, p=0.007). The absence of all risk predictors was associated with a 91.1% negative predictive value for the primary outcome and 96.6% for total mortality.
In non-ischemic HF patients, elevated galectin-3 levels did not predict major arrhythmic events but were associated with total mortality. Absence of risk predictors revealed a prevalent subgroup of HF patients with an excellent prognosis.
非缺血性病因心力衰竭（HF）患者的风险分层仍然具有临床挑战性。半乳糖凝集素-3 是一种纤维化的血清标志物，可能有助于预后判断。
确定半乳糖凝集素-3 作为预测主要心律失常事件和总死亡率的指标。
我们进行了一项前瞻性队列研究，纳入了 148 例非缺血性 HF 患者。所有患者均接受了全面的基线临床和实验室评估，包括血清半乳糖凝集素-3 水平。主要结局是心律失常性晕厥、适当的植入式心脏复律除颤器治疗、持续性室性心动过速或心源性猝死的发生。次要结局是全因死亡。所有统计检验中，双侧 p 值<0.05 被认为具有统计学意义。
在中位随访 941 天期间，主要和次要结局分别在 26（17.5%）和 30（20%）患者中发生。血清半乳糖凝集素-3>22.5ng/mL（最高四分位数）不能预测严重心律失常事件（HR：1.98，p=0.152）。主要结局的独立预测因素包括左心室舒张末期直径（LVEDD）>73mm（HR：3.70，p=0.001）、心肺运动试验中的运动周期性呼吸（EPB）（HR：2.67，p=0.01）和动态心电图监测中>8 次非持续性室性心动过速（NSVT）（HR：3.47，p=0.027）。全因死亡的预测因素包括半乳糖凝集素-3>22.5ng/mL（HR：3.69，p=0.001）、LVEDD>73mm（HR：3.35，p=0.003）、EPB（HR：3.06，p=0.006）和>8 次 NSVT（HR：3.95，p=0.007）。没有所有风险预测因素与主要结局的阴性预测值为 91.1%，总死亡率为 96.6%相关。
在非缺血性 HF 患者中，升高的半乳糖凝集素-3 水平不能预测主要心律失常事件，但与总死亡率相关。无风险预测因素揭示了 HF 患者中具有极好预后的普遍亚组。
