title: Usefulness of combining galectin-3 and BIVA assessments in predicting short- and long-term events in patients admitted for acute heart failure.
abstract: BACKGROUND
  Acute heart failure (AHF) is associated with a higher risk for the occurrence of rehospitalization and death. Galectin-3 (GAL3) is elevated in AHF patients and is an indicator in predicting short-term mortality. The total body water using bioimpedance vector analysis (BIVA) is able to identify mortality within AHF patients. The aim of this study was to evaluate the short- and long-term predictive value of GAL3, BIVA, and the combination of both in AHF patients in Emergency Department (ED).
  
  
  METHODS
  205 ED patients with AHF were evaluated by testing for B type natriuretic peptide (BNP) and GAL3. The primary endpoint was death and rehospitalization at 30, 60, 90, and 180 days and 12 and 18 months. AHF patients were evaluated at the moment of ED arrival with clinical judgment and GAL3 and BIVA measurement.
  
  
  RESULTS
  GAL3 level was significantly higher in patients >71 years old, and with eGFR < 30 cc/min. The area under the curve (AUC) of GAL3 + BIVA, GAL3 and BIVA for death and rehospitalization both when considered in total and when considered serially for the follow-up period showed that the combination has a better prognostic value. Kaplan-Meier survival curve for GAL3 values >17.8 ng/mL shows significant survival difference. At multivariate Cox regression analysis GAL3 is an independent variable to predict death + rehospitalization with a value of 32.24 ng/mL at 30 days (P < 0.005).
  
  
  CONCLUSIONS
  In patients admitted for AHF an early assessment of GAL3 and BIVA seems to be useful in identifying patients at high risk for death and rehospitalization at short and long term. Combining the biomarker and the device could be of great utility since they monitor the severity of two pathophysiological different mechanisms: heart fibrosis and fluid overload.
authors.affiliation: Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: De Berardinis
authors.affiliation: Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Magrini
authors.affiliation: Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Zampini
authors.affiliation: Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Zancla
authors.affiliation: Clinical and Molecular Medicine Department, Sapienza University of Rome, Sant'Andrea Hospital, 00189 Rome, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Salerno
authors.affiliation: Clinical and Molecular Medicine Department, Sapienza University of Rome, Sant'Andrea Hospital, 00189 Rome, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Cardelli
authors.affiliation: Institute of Biochemistry and Clinical Biochemistry, Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Di Stasio
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Hanna K
authors.initials: HK
authors.lastname: Gaggin
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Arianna
authors.initials: A
authors.lastname: Belcher
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Blair A
authors.initials: BA
authors.lastname: Parry
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Nagurney
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.affiliation: Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
mesh_terms: D000208:Acute Disease / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D017097:Electric Impedance; D005260:Female; D037502:Galectin 3 / Q000097:blood*; D006333:Heart Failure / Q000097:blood* / Q000401:mortality* / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D012307:Risk Factors
chemical_list: D037502:Galectin 3; D020097:Natriuretic Peptide, Brain
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