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CLINICAL RESEARCH: HEART FAILURE

Utility of Amino-Terminal Pro-Brain Natriuretic Peptide, Galectin-3, and Apelin for the Evaluation of Patients With Acute Heart Failure

Roland R. van Kimmenade, MD, PhD^_*, James L. Januzzi, Jr, MD, FACC, Patrick T. Ellinor, MD, PhD, Umesh C. Sharma, MB, BS, PhD^_*, Jaap A. Bakker, MSc, Adrian F. Low, MB, BS, Abelardo Martinez, MD, Harry J. Crijns, MD, PhD^_*, Calum A. MacRae, MB, ChB, PhD, Paul P. Menheere, PhD and Yigal M. Pinto, MD, PhD^_*,_*

^_* Department of Cardiology, University Hospital Maastricht, Maastricht, the Netherlands
Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
Department of Clinical Chemistry, University Hospital Maastricht, Maastricht, the Netherlands.

Manuscript received August 16, 2005; revised manuscript received January 3, 2006, accepted March 28, 2006.

^_* Reprint requests and correspondence: Dr. Yigal M. Pinto, Department of Cardiology and Experimental Cardiology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, the Netherlands. (Email: y.pinto{at}cardio.azm.nl).

OBJECTIVES: This study sought to explore the role of new biomarkers in heart failure (HF).

BACKGROUND: We investigated the utility of novel serum markers alone or together with natriuretic peptide testing for diagnosis and short-term prognosis estimation in subjects with acute HF.

METHODS: Plasma levels of amino-terminal pro-brain natriuretic peptide (NT-proBNP), apelin, and galectin-3 were measured in 599 patients presenting with dyspnea at the emergency department, of which 209 (35%) had acute HF.

RESULTS: The NT-proBNP was superior to either apelin or galectin-3 for diagnosis of acute HF, although galectin-3 levels were significantly higher in subjects with HF compared with those without. Receiver operating characteristic analysis for mortality prediction showed that, for 60-day prognosis, galectin-3 had the greatest area under the curve (AUC) at 0.74 (p = 0.0001), whereas NT-proBNP and apelin had an AUC of 0.67 (p = 0.009) and 0.54 (p = 0.33). In a multivariate logistic regression analysis, an elevated level of galectin-3 was the best independent predictor of 60-day mortality (odds ratio 10.3, p < 0.01) or the combination of death/recurrent HF within 60 days (odds ratio 14.3, p < 0.001). The Kaplan-Meier analyses showed that the combination of an elevated galectin-3 with NT-proBNP was a better predictor of mortality than either of the 2 markers alone.

CONCLUSIONS: Our data show potential utility of galectin-3 as a useful marker for evaluation of patients with suspected or proven acute HF, whereas apelin measurement was not useful for these indications. Moreover, the combination of galectin-3 with NT-proBNP was the best predictor for prognosis in subjects with acute HF.

Abbreviations and Acronyms   AUC = area under the curve   BNP = brain natriuretic peptide   CAD = coronary artery disease   CI = confidence interval   gal = galectin   HF = heart failure   IQR = interquartile range   NT-proBNP = amino-terminal pro-brain natriuretic peptide   NYHA = New York Heart Association   OR = odds ratio   PRIDE = N-Terminal Pro-BNP Investigation of Dyspnea in the Emergency Department   ROC = receiver-operating characteristic

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