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Gal-3 y ST2 como biomarcadores: un paso al frente en el pronóstico de la Insuficiencia Cardíaca
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Abstract(s)
Aims: The American College of Cardiology (ACA)/ American Heart Association (AHA) granted Galectin-3 (Gal-3) and Suppression of Tumorigenicity 2 (ST2)
evaluation a class II recommendation for HF prognosis, as an adjunctive to conventional clinical risk factors and natriuretic peptides dosing in 2013.
However, in Europe this endorsement is not valid. The purpose of this study was to study the association of Gal-3 and ST2 collected at-admission with
early (defined as the period of 90 days post-discharge) rehospitalization and overall mortality, and end of follow-up overall mortality in HF patients. Additionally, aminoterminal B-type natriuretic peptide (NT-proBNP) at admission was considered to test if a multi-marker strategy could yield supplementary
information.
Material and Methods: Gal-3, ST2 and NT-proBNP were assessed in patients hospitalized with acute decompensated HF in class III or IV of New York
Heart Association (NYHA). Univariate Cox proportional hazard model was used to assess the relationship between variables and outcomes. Since there are
no standardized cut-offs for Gal-3 and ST2, the multiclass Area Under the Curve Receiver-Operator Characteristic (AUCROC) as defined by Hand and Till
was used to evaluate the overall performance of each biomarker as a predictor of the outcomes.
Results: We followed 65 patients for a median of 13.7 (Q1-Q3 6.7-18.9) months. Gal-3 correlated with short-term rehospitalization (HR: 9.886, 95% CI:
2.027-48.214, P-value=0.005), short-term mortality (HR: 13.731, 95% CI: 1.650-114.276, P value=0.015) and end of follow-up mortality (HR: 4.492,
95% CI: 1.594-12.656, P-value=0.004). The association of elevated NT-proBNP determinations increased the risk of short-term rehospitalization (HR:
11.985, 95% CI: 1.962-73.218, P value=0.007) and end of follow-up mortality (HR: 78.025, 95% CI: 7.592-801.926, P-value<0.001). ST2 correlated
with end of follow-up mortality (HR: 4.846, 95% CI: 1.396-16.825, P-value=0.013). The risk further increased if NT-proBNP (HR: 5.953, 95% CI: 1.683-
21.055, P-value=0.006) or Gal-3 determinations (HR: 6.209, 95% CI: 2.393-16.114, P-value<0.001) were added.
Conclusions: Elevated Gal-3 concentrations correlated with short-term rehospitalization, short-term mortality and end of follow-up mortality; whereas
ST2 prognosticated end of follow-up mortality. Collective analysis with elevated NT-proBNP values further increased the outcomes’ risk. These results
corroborate the assumption that promising novel biomarkers Gal-3 and ST2 could be valuable for HF risk stratification. We highlight that a multi-marker
strategy added information, as a synergism between myocardial fibrosis biomarkers and the myocardial stretch peptide was observed.
Description
Keywords
Biomarcadores Galectina 3 Insuficiência Cardíaca Proteína 1 Semelhante a Receptor de Interleucina-1 Prognóstico Biomarkers Galectin 3 Heart Failure Interleukin-1 Receptor-Like 1 Protein Prognosis
Citation
Galicia Clin. 2021; 82-3: 146-151