Serum Galectin-3 Predicts Mortality in Venoarterial Extracorporeal Membrane Oxygenation Patients

Objective

We investigated the potential use of galectin-3 (Gal-3) as a prognostic indicator for patients with cardiogenic shock and developed a predictive mortality model for venoarterial extracorporeal membrane oxygenation (VA-ECMO).

Methods

We prospectively studied patients (survivors and nonsurvivors) who received VA-ECMO for cardiogenic shock from 2019 to 2021. We recorded baseline data, Gal-3, and B-type natriuretic peptide (BNP) before ECMO and 24-72 h after ECMO. We used multivariable logistic regression to analyze significant risk factors and construct a VA-ECMO death prediction model. Receiver operating characteristic (ROC) curves were plotted to assess the predictive efficacy of the model.

Results

We enrolled 73 patients with cardiogenic shock who received VA-ECMO support; 38 (52.05%) died in hospital. The median age was 57 years (interquartile range (IQR): 48-67 years); the median duration of ECMO therapy was 5.8 days (IQR: 4.62-7.57 days); and the median intensive care unit stay was 19.04 days (IQR: 13.92-26.15 days). Compared with the nonsurvivors, survivors had lower acute physiology and chronic health evaluation (APACHE) II scores (p < 0.001), increased left ventricular ejection fraction (p < 0.05), lower Gal-3 levels at 24 and 72 h (both p = 0.001), lower BNP levels at 24 and 72 h (both p = 0.001), and higher platelet counts (p = 0.009). Further multivariable analysis showed that APACHE II score, BNP-T72, and Gal-3-T72 were independent risk factors for death in VA-ECMO patients. Gal-3 and BNP were positively correlated (p < 0.05) and decreased significantly during ECMO treatment. The areas under the ROC curve (AUC) for APACHE II score, Gal-3-T72, and BNP-T72 were 0.687, 0.799, and 0.723, respectively. We constructed a combined prediction model with an AUC of 0.884 (p < 0.01).

Conclusion

Gal-3 may serve as a prognostic indicator for patients receiving VA-ECMO for cardiogenic shock. The combined early warning score is a simple and effective tool for predicting mortality in VA-ECMO patients.

Could Endothelin-1 Be a Promising Neurohormonal Biomarker in Acute Heart Failure?

Acute heart failure (AHF) is a life-threatening condition with high morbidity and mortality. Even though this pathology has been extensively researched, there are still challenges in establishing an accurate and early diagnosis, determining the long- and short-term prognosis and choosing a targeted therapeutic strategy. The use of reliable biomarkers to support clinical judgment has been shown to improve the management of AHF patients. Despite a large pool of interesting candidate biomarkers, endothelin-1 (ET-1) appears to be involved in multiple aspects of AHF pathogenesis that include neurohormonal activation, cardiac remodeling, endothelial dysfunction, inflammation, atherosclerosis and alteration of the renal function. Since its discovery, numerous studies have shown that the level of ET-1 is associated with the severity of symptoms and cardiac dysfunction in this pathology. The purpose of this paper is to review the existing information on ET-1 and answer the question of whether this neurohormone could be a promising biomarker in AHF.

Echocardiography E/A Abnormality is Associated with the Development of Primary Left Ventricle Remodeling in Middle-Aged and Elderly Women: A Longitudinal Study

Background

Impaired left ventricular (LV) relaxation is indicative of grade I diastolic dysfunction, which is mainly assessed by late diastolic transmitral flow velocity (E/A ratio). Although the E/A ratio has important diagnostic and prognostic implications with cardiac outcomes, the causal link between abnormal E/A ratio and left ventricle remodeling (LV remodeling) remains unclear.

Methods

A longitudinal analysis of 869 eligible women aged ≥45 years, who had received echocardiography scans as well as 5-year follow-up assessments between 2015 and 2020. Women with pre-existing cardiac abnormalities including grade II/III diastolic dysfunction as diagnosed by echocardiography, or structural heart disease were excluded. E/A abnormality was defined as baseline E/A ratio <0.8. The classification of LV remodeling was based on the measurements of left ventricular mass index (LVMI) and relative wall thickness (RWT). Logistic and linear regression models were used.

Results

Among the 869 women (60.71±10.01 years), 164 (18.9%) had developed LV remodeling after the 5-year follow-up. The proportion of women with E/A abnormality versus non-abnormality was also significantly different (27.13% vs 16.59%, P=0.007). Multivariable-adjusted regression models showed that E/A abnormality (OR: 4.14, 95%Cl:1.80-9.20, P=0.009) was significantly associated with higher risk of concentric hypertrophy (CH) after follow-up. No such association was found in either concentric remodeling (CR) or eccentric hypertrophy (EH). Higher baseline E/A ratio was correlated with lower ΔRWT during the 5-year follow-up (β=-0.006 m/s, 95% CI: -0.012 to -0.002, P=0.025), which was independent of demographics and biological factors.

Conclusion

E/A abnormality is associated with a higher risk of CH. Higher baseline E/A ratio may be associated with decreased relative changes in RWT.

Development and Validation of a Risk Score in Chinese Patients With Chronic Heart Failure

Background

Acute exacerbation of chronic heart failure contributes to substantial increases in major adverse cardiovascular events (MACE). The study developed a risk score to evaluate the severity of heart failure which was related to the risk of MACE.

Methods

This single-center retrospective observational study included 5,777 patients with heart failure. A credible random split-sample method was used to divide data into training and validation dataset (split ratio = 0.7:0.3). Least absolute shrinkage and selection operator (Lasso) logistic regression was applied to select predictors and develop the risk score to predict the severity category of heart failure. Receiver operating characteristic (ROC) curves, and calibration curves were used to assess the model’s discrimination and accuracy.

Results

Body-mass index (BMI), ejection fraction (EF), serum creatinine, hemoglobin, C-reactive protein (CRP), and neutrophil lymphocyte ratio (NLR) were identified as predictors and assembled into the risk score (P &lt; 0.05), which showed good discrimination with AUC in the training dataset (0.770, 95% CI:0.746–0.794) and validation dataset (0.756, 95% CI:0.717–0.795) and was well calibrated in both datasets (all P &gt; 0.05). As the severity of heart failure worsened according to risk score, the incidence of MACE, length of hospital stay, and treatment cost increased (P &lt; 0.001).

Conclusion

A risk score incorporating BMI, EF, serum creatinine, hemoglobin, CRP, and NLR, was developed and validated. It effectively evaluated individuals’ severity classification of heart failure, closely related to MACE.

Preventive Effect Observation of Dapagliflozin on Middle and Later Ventricular Remodeling in Patients with Acute ST Segment Elevation Anterior Wall Myocardial Infarction: A Single-Center, Retrospective Cohort Study

Objective: This study aimed to observe the effect of dapagliflozin on left ventricular ejection function (LVEF) and left ventricular end-diastolic volume (LVEDV) in patients with acute anesthesia ST segment elevation myocardial infarction (ASTEMI) and explore the effect of prophylactic treatment on ventricular remodeling (VR). Methods. A retrospective cohort design was employed to collect 188 patients with anterior wall STEMI who received emergency percutaneous coronary intervention (PCI). The patients were divided into dapagliflozin group and control group. The baseline data, the results of echocardiography at 6 months and on admission, and the proportion of VR were compared between the two groups. Echocardiography followed up for the two groups for 6 months after PCI and VR (LVEDV increased ≥20%) were considered the main clinical outcomes. Single-factor and multifactor logistic regression was conducted to explore the preventive effect of dapagliflozin on VR in patients with anterior wall STEMI. Results. There were significant differences in gender, history of diabetes, glycosylated hemoglobin (Hb1AC), admission LVEF, Killip grade of heart failure, and brain natriuretic peptide (BNP) between the dapagliflozin group and the control group regarding the baseline data. Compared with the results of echocardiography at admission and 6 months, the decrease in LVEDV and the increase of LVEF at 6 months in the dapagliflozin group were significantly higher than those in the control group. During the follow-up of 6 months, the VR rate in the dapagliflozin group was significantly lower than that in the control group. Multifactor logistic regression analysis suggested that the risk of VR was reduced by taking dapagliflozin after the adjustment of the confounding factors. Additionally, the combined use of dapagliflozin, ACEI/ARB, and β-block can further reduce the risk. Conclusion. Regular taking of dapagliflozin has a positive effect on the improvement of middle and LVEF and left ventricular volume enlargement in patients with anterior wall STEMI, as well as the prevention of the occurrence of VR.

Sex-Specific Effects of Prenatal Hypoxia on the Cardiac Endothelin System in Adult Offspring

Fetal hypoxia, a major consequence of complicated pregnancies, impairs offspring cardiac tolerance to ischemia/reperfusion (I/R) insult, however, the mechanisms remain unknown. Endothelin-1 (ET-1) signaling through the endothelin A receptors (ET_A) is associated with cardiac dysfunction. We hypothesized that prenatal hypoxia exacerbates cardiac susceptibility to I/R via increased ET-1 and ET_A levels, while ET_A inhibition ameliorates this. Pregnant Sprague-Dawley rats were exposed to normoxia (21% O₂) or hypoxia (11% O₂) on gestational days 15-21. Offspring were aged to 4 months, and hearts were aerobically perfused or subjected to ex vivo I/R, with or without pre-infusion with an ET_A antagonist (ABT-627). ET-1 levels were assessed with ELISA in aerobically perfused and post-I/R left ventricles (LV). ET_A and ET_B levels were assessed by Western blotting in non-perfused LV. As hypothesized, ABT-627 infusion tended to improve post-I/R recovery in hypoxic females (p=0.0528), however, surprisingly, ABT-627 prevented post-I/R recovery only in the hypoxic males (p<0.001). ET-1 levels were increased in post-I/R LV in both sexes regardless of the prenatal exposure (p<0.01). ET_A expression was similar among all groups, while ET_B (isoform C) levels were decreased in prenatally hypoxic females (p<0.05). In prenatally hypoxic males, ET_A signaling may be essential for tolerance to I/R, while in prenatally hypoxic females, ET_A may contribute to cardiac dysfunction. Our data illustrate that understanding the prenatal history has critical implications for treatment strategies in adult chronic diseases.

Relationship between Quantitative Parameters of Echocardiography and Vascular Endothelial Function in Patients with Chronic Heart Failure and Its Predictive Value for Short-Term MACE Risk

Objective

To investigate the relationship between quantitative parameters of echocardiography and vascular endothelial function in patients with chronic heart failure (CHF) and the predictive value of short-term major adverse cardiovascular events (MACE).

Methods

From February 2018 to February 2020, 86 CHF patients in our hospital were selected as the observation group, and 46 healthy subjects were selected as the control group during the same period. Quantitative parameters of echocardiography (left ventricular ejection fraction (LVEF), left ventricular short-axis shortening rate (FS), and ratio of peak flow velocity between early and late mitral valve diastole (E/A)) and endothelial function indexes (endothelin-1 (ET-1)/nitric oxide (NO)) were compared between the two groups. The correlation between quantitative parameters of echocardiography and vascular endothelial function in patients with CHF was analyzed. A logistic regression equation was used to analyze the risk factors of MACE in patients with CHF. The receiver operating characteristic curve (ROC) was used to analyze the predictive value of quantitative parameters of echocardiography and NO/ET-1 for the risk of MACE in patients with CHF.

Result

LVEF, FS, and NO/ET-1 in the observation group were lower than those in the control group, while E/A was higher than that in the control group (P < 0.05). In CHF patients, LVEF and FS were positively correlated with NO/ET-1, while E/A was negatively correlated with NO/ET-1 (P < 0.05). Logistic regression analysis showed that the decrease of LVEF, FS, NO/ET-1, and E/A were risk factors for MACE (P < 0.05) after adjusting for age, body mass index, and cardiac function grading. The AUC value of short-term MACE predicted by quantitative parameters of echocardiography and NO/ET-1 combined was 0.883, with a corresponding sensitivity of 86.21% and specificity of 73.13%.

Conclusion

Quantitative parameters of echocardiography in CHF patients are related to vascular endothelial function, and their combination can effectively predict the risk of MACE in the near future, providing reference for clinical treatment.