title: Renal function largely influences Galectin-3 prognostic value in heart failure.
abstract: BACKGROUND
  Galectin-3 (Gal-3) has been associated with cardiac remodeling and heart failure (HF) prognosis. Renal function is also a well known HF prognostic indicator. The link between renal insufficiency, HF, and Gal-3 is not completely elucidated.
  
  
  RESULTS
  We explored the association between Gal-3 and renal function in a cohort of 876 consecutive ambulatory patients with HF (mean age: 68 years; mean left ventricular ejection fraction [LVEF]: 36%), 52.2% had HF etiology of ischemic heart disease. Circulating Gal-3 was highly correlated with estimated glomerular filtration rate (eGFR), calculated with either the chronic kidney disease-epidemiology (CKD-EPI) equation (r = -0.64) or the CKD-EPI-cystatin-C equation (r = -0.59) and with Cystatin-C levels (r = 0.70), after adjusting for age, sex, New York Heart Association (NYHA) functional class, LVEF, and HF etiology (all p<0.001). Patients were stratified by CKD-EPI-eGFR (ml/min/1.73 m(2)), as follows: ≥ 60 (n = 218), 30 to 59 (n = 434), and <30 (n = 224). In these strata, Gal-3 significantly increased (median [IQR]: 12.3 [10.4-15.6]; 16.1 [13-19.8]; and 24.5 [20-33.8] ng/ml, respectively; trend p < 0.001). This was independent of NYHA functional class (I-II and III-IV) and LVEF (<45% and ≥ 45%). Gal-3 was associated with mortality in univariate analyses, but after adjusting for CKD-EPI-eGFR, the hazard ratios were 1.10 (95% CI: 0.89-1.34, p = 0.39) for all cause death, and 0.90 (95% CI: 0.68-1.21, p = 0.50) for cardiovascular death. Similar results were obtained with eGFRs calculated with the CKD-EPI-cystatin-C equation.
  
  
  CONCLUSIONS
  Circulating Gal-3 was highly associated with renal function in outpatients with HF. The value of Gal-3 for HF prognosis declined after adjusting for renal function.
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Spain.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Zamora
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Lupón
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: de Antonio
authors.affiliation: Biochemistry Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Galán
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Domingo
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Urrutia
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Spain.
authors.forename: Maribel
authors.initials: M
authors.lastname: Troya
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Spain. Electronic address: abayesgenis@gmail.com.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death / Q000639:trends; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D037502:Galectin 3 / Q000097:blood*; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D051437:Renal Insufficiency / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013030:Spain / Q000453:epidemiology; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D037502:Galectin 3
keywords: Biomarkers; Heart failure; Myocardial fibrosis; Remodeling; Renal failure