title: Association of galectin-3 and fibrosis markers with long-term cardiovascular outcomes in patients with heart failure, left ventricular dysfunction, and dyssynchrony: insights from the CARE-HF (Cardiac Resynchronization in Heart Failure) trial.
abstract: OBJECTIVE
  Circulating biomarkers of collagen turnover reflect extracellular cardiac matrix (ECCM) remodelling. The extent to which the success of cardiac resynchronization therapy (CRT) is influenced by the degree of cardiac fibrosis and whether CRT can influence matrix remodelling has yet to be studied. Our aim was to determine, in patients with heart failure (HF) and cardiac dyssynchrony, whether ECCM biomarkers are influenced by CRT and can predict cardiovascular outcomes and response to CRT.
  
  
  RESULTS
  Serum levels of ECCM biomarkers [galectin-3 (Gal-3), N-terminal propeptides of type I and III procollagens (PINP and PIIINP), type I collagen telopeptide (ICTP), and matrix metalloproteinase 1 (MMP-1)] were measured in 260 patients, in a substudy of CARE-HF, a randomized controlled trial which evaluated the effects of CRT in patients with left ventricular systolic dysfunction and cardiac dyssynchrony. ECCM biomarkers did not change throughout the 18-month follow-up period. In age- and gender-adjusted analyses, Gal-3 and PIIINP were associated with death or HF hospitalization. In a further multivariate model, Gal-3 >30 ng/mL was associated [OR (95% CI):2.98 (1.43-6.22), P = 0.004] with death or HF hospitalization, along with left ventricular end-systolic volume >200 mL [3.42 (OR: 1.65-7.10), P = 0.001]. The outcome death or left ventricular ejection fraction (LVEF) ≤35% was associated with MMP-1 [≤3 ng/mL: 3.04 (1.37-6.71), P = 0.006]. No significant interaction was observed between the tested biomarkers and the treatment group.
  
  
  CONCLUSIONS
  Increased Gal-3 and PIIINP, and low MMP-1 are associated with adverse long-term cardiovascular outcomes but did not predict response to CRT. CRT did not favourably affect serum concentrations of ECCM markers.
authors.affiliation: INSERM U961, CIC Inserm-CHU Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, 4 rue du Morvan, Vandoeuvre lès Nancy, France.
authors.forename: Natalia
authors.initials: N
authors.lastname: Lopez-Andrès
authors.forename: Patrick
authors.initials: P
authors.lastname: Rossignol
authors.forename: Wafae
authors.initials: W
authors.lastname: Iraqi
authors.forename: Renaud
authors.initials: R
authors.lastname: Fay
authors.forename: Josette
authors.initials: J
authors.lastname: Nuée
authors.forename: Stefano
authors.initials: S
authors.lastname: Ghio
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Patrick
authors.initials: P
authors.lastname: Lacolley
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D005260:Female; D005355:Fibrosis / Q000097:blood / Q000150:complications / Q000503:physiopathology; D037502:Galectin 3 / Q000097:blood*; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D020781:Matrix Metalloproteinase 1 / Q000097:blood*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011347:Procollagen / Q000097:blood*; D013318:Stroke Volume; D013995:Time; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000150:complications / Q000503:physiopathology; D020257:Ventricular Remodeling
chemical_list: D015415:Biomarkers; D037502:Galectin 3; D010446:Peptide Fragments; D011347:Procollagen; C041876:procollagen Type III-N-terminal peptide; D020781:Matrix Metalloproteinase 1