title: Galectin-3 Is Elevated and Associated With Adverse Outcomes in Patients With Single-Ventricle Fontan Circulation.
abstract: BACKGROUND
  Galectin-3 may play a role in cardiac and noncardiac fibrosis, and elevated circulating levels of this protein predict adverse outcomes in patients with heart failure who do not have congenital heart disease. We investigated galectin-3 in adults with single-ventricle Fontan circulation, patients who are prone to premature clinical deterioration in the context of extensive multiorgan fibrosis.
  
  
  RESULTS
  We measured plasma galectin-3 concentrations in 70 ambulatory adult Fontan patients and 21 age- and sex-matched control participants. Galectin-3 level was significantly higher in the Fontan group (11.85 ng/mL, interquartile range 9.9 to 15.0 ng/mL) versus the control group (9.4 ng/mL, interquartile range 8.2 to 10.8 ng/mL; P<0.001). Among Fontan patients, galectin-3 was positively correlated with age, uric acid, and high-sensitivity C-reactive protein and negatively correlated with estimated glomerular filtration rate. There was no significant relationship between galectin-3 and oxygen saturation, Fontan type, or ventricular morphology. Over a median follow-up of 461 days, 15 events occurred among the Fontan patients: 12 nonelective hospitalizations (with 2 subsequent deaths) and 3 deaths without prior hospitalization. Patients with elevated galectin-3 (n=19, defined as >2 SD above the control group mean value) had a higher risk of nonelective hospitalization or death (hazard ratio 6.0, 95% CI 2.1 to 16.8, P<0.001). This relationship persisted after individual adjustment for covariates including age, New York Heart Association functional class, C-reactive protein, and estimated glomerular filtration rate and after multivariable adjustment for independently predictive covariates (hazard ratio 9.2, 95% CI 2.4 to 35.2, P=0.001).
  
  
  CONCLUSIONS
  Galectin-3 concentrations are elevated among adults with a Fontan circulation, and elevated galectin-3 is associated with an increased risk of nonelective cardiovascular hospitalization or death.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.R.O., M.N.S., A.M.V., F.W., S.C., M.J.L.) Department of Cardiology, Boston Children's Hospital, Boston, MA (A.R.O., J.O., B.L., M.N.S., A.M.V., F.W., M.J.L.).
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Opotowsky
authors.affiliation: División de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile (F.B.).
authors.forename: Fernando
authors.initials: F
authors.lastname: Baraona
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA (A.R.O., J.O., B.L., M.N.S., A.M.V., F.W., M.J.L.).
authors.forename: Justin
authors.initials: J
authors.lastname: Owumi
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA (A.R.O., J.O., B.L., M.N.S., A.M.V., F.W., M.J.L.).
authors.forename: Brittani
authors.initials: B
authors.lastname: Loukas
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.R.O., M.N.S., A.M.V., F.W., S.C., M.J.L.) Department of Cardiology, Boston Children's Hospital, Boston, MA (A.R.O., J.O., B.L., M.N.S., A.M.V., F.W., M.J.L.).
authors.forename: Michael N
authors.initials: MN
authors.lastname: Singh
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.R.O., M.N.S., A.M.V., F.W., S.C., M.J.L.) Department of Cardiology, Boston Children's Hospital, Boston, MA (A.R.O., J.O., B.L., M.N.S., A.M.V., F.W., M.J.L.).
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Valente
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.R.O., M.N.S., A.M.V., F.W., S.C., M.J.L.) Department of Cardiology, Boston Children's Hospital, Boston, MA (A.R.O., J.O., B.L., M.N.S., A.M.V., F.W., M.J.L.).
authors.forename: Fred
authors.initials: F
authors.lastname: Wu
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.R.O., M.N.S., A.M.V., F.W., S.C., M.J.L.) Framingham Heart Study, Framingham, MA (S.C.).
authors.forename: Susan
authors.initials: S
authors.lastname: Cheng
authors.affiliation: Cincinnati Children's Hospital Heart Institute, Cincinnati, OH (G.V.).
authors.forename: Gruschen
authors.initials: G
authors.lastname: Veldtman
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA (E.B.R.) Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA (E.B.R.).
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.R.O., M.N.S., A.M.V., F.W., S.C., M.J.L.) Department of Cardiology, Boston Children's Hospital, Boston, MA (A.R.O., J.O., B.L., M.N.S., A.M.V., F.W., M.J.L.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Landzberg
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001798:Blood Proteins; D016022:Case-Control Studies; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects* / Q000401:mortality; D037502:Galectin 3 / Q000097:blood*; D037161:Galectins; D006330:Heart Defects, Congenital / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001798:Blood Proteins; D037502:Galectin 3; D037161:Galectins; C428445:LGALS3 protein, human
keywords: Fontan procedure; adult congenital heart disease; biomarker; congenital heart disease; galectin‐3