title: Galectin-3 Levels Are Elevated and Predictive of Mortality in Pulmonary Hypertension.
abstract: BACKGROUND
  Galectin-3, a novel binding-lectin involved in inflammation and fibrosis, is elevated in heart failure and is independently predictive of mortality in this condition. We sought to evaluate galectin-3 levels and its prognostic value in patients with pulmonary hypertension (PH), a known inflammatory state, in the setting of pulmonary arterial hypertension (PAH) and in heart failure with preserved ejection fraction-associated PH (HFpEF-PH).
  
  
  METHODS
  We measured galectin-3 levels in 76 patients with PH; 37 patients with PAH and 39 patients with HFpEF-PH. Baseline characteristics, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels were assessed. Univariate and multivariate analyses were used to assess the prognostic value of galectin-3.
  
  
  RESULTS
  Median (IQR) galectin-3 (ng/mL) for the entire cohort was 24.65 (IQR=10.39, 32.90); 22.33 (IQR=18.94, 27.30) and 28.94 (IQR=21.67, 39.85) in the PAH and HFpEF-PH, respectively (p=0.07). After evaluation of the galectin-3 levels by tertile, mortality rates were 16% (4/25), 34.6% (9/26), and 48% (12/25) in tertiles 1-3, respectively, and Kaplan-Meier analysis revealed a significant increase in mortality across increasing galectin-3 tertiles (log-rank p=0.014). On Cox regression analysis, galectin-3 was a strong predictor of mortality on both univariate HR=2.09 per tertile (95% CI=1.21, 3.62 per tertile; p-trend=0.008) and multivariate analysis HR=2.19 per tertile (95% CI=1.06, 4.54; p-trend=0.035) after adjusting for age, sex, race, glomerular filtration rate (eGFR), NT-proBNP, medications, and aetiology of PH (PAH vs. HFpEF-PH).
  
  
  CONCLUSIONS
  Galectin-3 is a strong, independent prognostic marker in PH, regardless of aetiology. Larger studies should further evaluate the role of galectin-3 as a prognostic biomarker and possible therapeutic target in PH.
authors.affiliation: Cardiovascular Division, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA. Electronic address: jeremy.mazurek@uphs.upenn.edu.
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Mazurek
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Horne
authors.affiliation: Cardiovascular Division, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Wajeeha
authors.initials: W
authors.lastname: Saeed
authors.affiliation: Cardiovascular Division, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Sardar
authors.affiliation: Cardiovascular Division, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Zolty
mesh_terms: D000368:Aged; D001798:Blood Proteins; D018572:Disease-Free Survival; D005260:Female; D037502:Galectin 3 / Q000097:blood*; D037161:Galectins; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D015996:Survival Rate
chemical_list: D001798:Blood Proteins; D037502:Galectin 3; D037161:Galectins; C428445:LGALS3 protein, human; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Galectin-3; HFpEF; Prognosis; Pulmonary arterial hypertension; Pulmonary hypertension