Author + information
- Quynh A. Truong,
- Wai-ee Thai,
- Jackie Szymonifka,
- Sandeep Basnet,
- Bryan Wai,
- Zachary Grunau,
- Jonathan Beaudoin,
- Chelsea L. Smith,
- Adefolakemi Babatunde,
- Olujimi Ajijola,
- Jagmeet Singh and
- James Januzzi
Galectin-3 (Gal-3) is an emerging marker of cardiac fibrosis and associated with heart failure (HF) outcomes. Coronary sinus (CS) blood can be sampled readily in patients undergoing cardiac resynchronization therapy (CRT) and circulating biomarker levels may differ between vascular beds. Thus, we examined the differences between CS and peripheral venous (PV) blood levels for predicting major adverse cardiac events (MACE) in patients undergoing CRT.
In 69 patients (age 67±12; 83% male; EF 28±8%; 51% ischemic cardiomyopathy; 94% NYHA Class ll-lll), we measured Gal-3 levels (BG Medicine, Waltham, MA) from baseline CS and PV plasma samples simultaneously drawn at the time of device implantation. MACE was defined as the composite endpoint of death, cardiac transplant, left ventricular assist device (LVAD), and HF hospitalization at 6 months. Gal-3 levels >25.9 ng/mL were considered elevated, based on the manufacturer's definition of high-risk.
The median CS Gal-3 concentration was 17.1 ng/mL [IQR 12.3, 21.0] and PV concentration was 18.1 ng/mL [IQR 13.5, 23.2]. Overall, there were 11 (16%) patients with MACE. There were 9 (13%) patients with elevated CS levels and 13 (19%) patients with elevated PV levels. For predicting MACE, an elevated CS Gal-3 concentration had a sensitivity 36%, specificity 91%, negative predictive value (NPV) 88%, positive predictive value (PPV) 44%; while elevated PV level had a sensitivity 18%, specificity 81%, NPV 84%, PPV 15%. Patients with elevated CS levels had a 6-fold increase in odds for having MACE as compared to those with low CS levels (odds ratio [OR] 6.1, 95% confidence interval [CI] 1.3-28.1, p=0.02). In contrast, no difference in MACE was seen in patients with elevated PV levels as compared to low PV levels (OR 0.9, 95% CI 0.2-5.0, p=0.95).
In patients undergoing CRT, elevated coronary sinus concentrations of Gal-3 are superior to PV values for predicting MACE. Our findings suggest that there is differential expression of Gal-3 levels between the CS and periphery. Further analyses of this marker to CRT response and structural remodeling are underway.
Oral Contributions West, Room 3009
Saturday, March 09, 2013, 8:45 a.m.-9:00 a.m.
Session Title: Management Issues in the Pacemaker and ICD Patient
Abstract Category: 8. Arrhythmias: Devices
Presentation Number: 903-6
- 2013 American College of Cardiology Foundation