New Biomarker, Galectin-3, Shows Risk-Stratification Potential in Chronic Heart Failure

September 29, 2009

September 29, 2009 (Boston, Massachusetts) — The search for biomarkers that can forecast risk of heart failure worsening and hospitalization, one of the most active research areas in cardiology, has turned up a promising one in the inflammation and fibrosis mediator galectin-3, suggests observational data from a randomized trial [1].

Galectin-3 is upregulated in cardiomyopathy and heart failure, and a wealth of evidence from animals and some from clinical studies has suggested it plays a role in the progression of heart failure and remodeling, observed Dr Dirk J van Veldhuisen (University Medical Center Groningen, the Netherlands) at the Heart Failure Society of America 2009 Scientific Meeting.

Van Veldhuisen presented new evidence, based on a retrospective look at data from the Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) trial [2], that elevations in galectin-3 point to an increased risk of death or HF hospitalization, which was the main trial's primary end point.

COACH compared two disease-management strategies with conventional management in 1023 survivors of a heart-failure hospitalization, finding no significant differences in the primary end point among the groups at 18 months. As previously reported by heartwire , the negative result was attributed to good outcomes in the control group.

In the current analysis, the risk of death/HF hospitalization was increased >2.5 times (p<0.0001) for the trial's patients in highest quartile for baseline levels of galectin-3 compared with those in the lowest quartile, independently of age, sex, and natriuretic peptide levels, he reported.

Adjusted* Hazard Ratio (HR) for Death or Heart-Failure Hospitalization at 18 Months by Baseline Galectin-3 Level Quartiles vs Quartile 1 (5.0–15.2 Ng/Ml)

Galectin-3 quartile (ranges, ng/mL) HR (95% CI) p
Quartile 2 (15.2–20.0) 1.67 (1.08–2.59) 0.0207
Quartile 3 (20.0–25.9) 2.08 (1.35–3.21) 0.0010
Quartile 4 (25.9–66.6) 2.67 (1.74–4.09) <0.0001
*Adjusted for age, sex, and b-type natriuretic peptide levels

Patients whose galectin-3 levels went up by a factor of two during the study had two times the absolute risk of death/HF hospitalization (hazard ratio [HR] 1.99; 95% CI, 1.63–2.43; p<0.0001). The risk increase was still strongly significant after adjustment for age, sex, natriuretic peptide levels, and kidney function as gauged by estimated glomerular filtration rate (eGFR), with an HR of 1.44 (95% CI 1.12–1.86; p=0.0052).

As the invited commenter after the presentation, Dr Inder S Anand (University of Minnesota and Veterans Affairs Medical Center, Minneapolis) agreed that a lot of evidence points to galectin-3 as "a promising new biomarker in heart failure." But before it could be used as one, he said, further studies need to clarify its relationship to heart-failure pathophysiology and progression and determine for sure "whether galectin-3 provides substantial incremental prognostic information beyond that offered by the currently available biomarkers."

Van Veldhuisen reports receiving consulting fees from BG Medicine, which is vying to market an assay for galectin-3. Anand had no disclosures.

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