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Abstract
Despite recent advances in the treatment of chronic heart failure, therapeutic options for acute heart failure (AHF) remain limited. AHF admissions are associated with significant multi-organ dysfunction, especially worsening renal failure, which results in significant morbidity and mortality. There are several aspects of AHF management: diagnosis, decongestion, vasoactive therapy, goal-directed medical therapy initiation and safe transition of care. Effective diagnosis and prognostication could be very helpful in an acute setting and rely upon biomarker evaluation with noninvasive assessment of fluid status. Decongestive strategies could be tailored to include pharmaceutical options along with consideration of utilizing ultrafiltration for refractory hypervolemia. Vasoactive agents to augment cardiac function have been evaluated in patients with AHF but have shown to only have limited efficacy. Post stabilization, initiation of quadruple goal-directed medical therapy—angiotensin receptor-neprilysin inhibitors, mineral receptor antagonists, sodium glucose type 2 (SGLT-2) inhibitors, and beta blockers—to prevent myocardial remodeling is being advocated as a standard of care. Safe transition of care is needed prior to discharge to prevent heart failure rehospitalization and mortality. Post-discharge close ambulatory monitoring (including remote hemodynamic monitoring), virtual visits, and rehabilitation are some of the strategies to consider. We hereby review the contemporary approach in AHF diagnosis and management.
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Affiliation(s)
- Hayaan Kamran
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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Nguyen MN, Su Y, Vizi D, Fang L, Ellims AH, Zhao WB, Kiriazis H, Gao XM, Sadoshima J, Taylor AJ, McMullen JR, Dart AM, Kaye DM, Du XJ. Mechanisms responsible for increased circulating levels of galectin-3 in cardiomyopathy and heart failure. Sci Rep 2018; 8:8213. [PMID: 29844319 PMCID: PMC5973942 DOI: 10.1038/s41598-018-26115-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/16/2018] [Indexed: 12/12/2022] Open
Abstract
Galectin-3 is a biomarker of heart disease. However, it remains unknown whether increase in galectin-3 levels is dependent on aetiology or disease-associated conditions and whether diseased heart releases galectin-3 into the circulation. We explored these questions in mouse models of heart disease and in patients with cardiomyopathy. All mouse models (dilated cardiomyopathy, DCM; fibrotic cardiomyopathy, ischemia-reperfusion, I/R; treatment with β-adrenergic agonist isoproterenol) showed multi-fold increases in cardiac galectin-3 expression and preserved renal function. In mice with fibrotic cardiomyopathy, I/R or isoproterenol treatment, plasma galectin-3 levels and density of cardiac inflammatory cells were elevated. These models also exhibited parallel changes in cardiac and plasma galectin-3 levels and presence of trans-cardiac galectin-3 gradient, indicating cardiac release of galectin-3. DCM mice showed no change in circulating galectin-3 levels nor trans-cardiac galectin-3 gradient or myocardial inflammatory infiltration despite a 50-fold increase in cardiac galectin-3 content. In patients with hypertrophic cardiomyopathy or DCM, plasma galectin-3 increased only in those with renal dysfunction and a trans-cardiac galectin-3 gradient was not present. Collectively, this study documents the aetiology-dependency and diverse mechanisms of increment in circulating galectin-3 levels. Our findings highlight cardiac inflammation and enhanced β-adrenoceptor activation in mediating elevated galectin-3 levels via cardiac release in the mechanism.
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Affiliation(s)
- My-Nhan Nguyen
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Yidan Su
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Donna Vizi
- Department of Cardiovascular Medicine, the Alfred Hospital, Melbourne, Australia
| | - Lu Fang
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiovascular Medicine, the Alfred Hospital, Melbourne, Australia
| | - Andris H Ellims
- Department of Cardiovascular Medicine, the Alfred Hospital, Melbourne, Australia
| | - Wei-Bo Zhao
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Helen Kiriazis
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Xiao-Ming Gao
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Junichi Sadoshima
- Department of Cell Biology and Molecular Medicine Rutgers, New Jersey Medical School, New Jersey, USA
| | - Andrew J Taylor
- Department of Cardiovascular Medicine, the Alfred Hospital, Melbourne, Australia
| | - Julie R McMullen
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Anthony M Dart
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia.,Department of Cardiovascular Medicine, the Alfred Hospital, Melbourne, Australia
| | - David M Kaye
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia.,Department of Cardiovascular Medicine, the Alfred Hospital, Melbourne, Australia
| | - Xiao-Jun Du
- Baker Heart and Diabetes Institute, Melbourne, Australia. .,Central Clinical School, Monash University, Melbourne, Australia.
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Hogas S, Bilha SC, Branisteanu D, Hogas M, Gaipov A, Kanbay M, Covic A. Potential novel biomarkers of cardiovascular dysfunction and disease: cardiotrophin-1, adipokines and galectin-3. Arch Med Sci 2017; 13:897-913. [PMID: 28721158 PMCID: PMC5507105 DOI: 10.5114/aoms.2016.58664] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/30/2015] [Indexed: 12/22/2022] Open
Abstract
Cardiovascular disease is one of the main burdens of healthcare systems worldwide. Nevertheless, assessing cardiovascular risk in both apparently healthy individuals and low/high-risk patients remains a difficult issue. Already established biomarkers (e.g. brain natriuretic peptide, troponin) have significantly improved the assessment of major cardiovascular events and diseases but cannot be applied to all patients and in some cases do not provide sufficiently accurate information. In this context, new potential biomarkers that reflect various underlying pathophysiological cardiac and vascular modifications are needed. Also, a multiple biomarker evaluation that shows changes in the cardiovascular state is of interest. This review describes the role of selected markers of vascular inflammation, atherosclerosis, atherothrombosis, endothelial dysfunction and cardiovascular fibrosis in the pathogenesis and prognosis of cardiovascular disease: the potential use of cardiotrophin-1, leptin, adiponectin, resistin and galectin-3 as biomarkers for various cardiovascular conditions is discussed.
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Affiliation(s)
- Simona Hogas
- Nephrology Department, Dialysis and Renal Transplant Center, "C.I. Parhon" University Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Stefana C Bilha
- Endocrinology Department, "Sf. Spiridon" Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Dumitru Branisteanu
- Endocrinology Department, "Sf. Spiridon" Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Mihai Hogas
- Physiology Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Abduzhappar Gaipov
- Extracorporeal Hemocorrection Unit, JSC "National Scientific Medical Research Center", Astana, Kazakhstan
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Adrian Covic
- Nephrology Department, Dialysis and Renal Transplant Center, "C.I. Parhon" University Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
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Souza BSDF, Silva DN, Carvalho RH, Sampaio GLDA, Paredes BD, Aragão França L, Azevedo CM, Vasconcelos JF, Meira CS, Neto PC, Macambira SG, da Silva KN, Allahdadi KJ, Tavora F, de Souza Neto JD, Dos Santos RR, Soares MBP. Association of Cardiac Galectin-3 Expression, Myocarditis, and Fibrosis in Chronic Chagas Disease Cardiomyopathy. Am J Pathol 2017; 187:1134-1146. [PMID: 28322201 DOI: 10.1016/j.ajpath.2017.01.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/19/2017] [Indexed: 01/30/2023]
Abstract
Chronic Chagas disease cardiomyopathy, caused by Trypanosoma cruzi infection, is a major cause of heart failure in Latin America. Galectin-3 (Gal-3) has been linked to cardiac remodeling and poor prognosis in heart failure of different etiologies. Herein, we investigated the involvement of Gal-3 in the disease pathogenesis and its role as a target for disease intervention. Gal-3 expression in mouse hearts was evaluated during T. cruzi infection by confocal microscopy and flow cytometry analysis, showing a high expression in macrophages, T cells, and fibroblasts. In vitro studies using Gal-3 knockdown in cardiac fibroblasts demonstrated that Gal-3 regulates cell survival, proliferation, and type I collagen synthesis. In vivo blockade of Gal-3 with N-acetyl-d-lactosamine in T. cruzi-infected mice led to a significant reduction of cardiac fibrosis and inflammation in the heart. Moreover, a modulation in the expression of proinflammatory genes in the heart was observed. Finally, histological analysis in human heart samples obtained from subjects with Chagas disease who underwent heart transplantation showed the expression of Gal-3 in areas of inflammation, similar to the mouse model. Our results indicate that Gal-3 plays a role in the pathogenesis of experimental chronic Chagas disease, favoring inflammation and fibrogenesis. Moreover, by demonstrating Gal-3 expression in human hearts, our finding reinforces that this protein could be a novel target for drug development for Chagas cardiomyopathy.
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Affiliation(s)
- Bruno Solano de Freitas Souza
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil; Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | | | | | | | - Bruno Diaz Paredes
- Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | | | - Carine Machado Azevedo
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil; Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | - Juliana Fraga Vasconcelos
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil; Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | - Cassio Santana Meira
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil; Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | - Paulo Chenaud Neto
- Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | - Simone Garcia Macambira
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil; Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil; Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
| | - Kátia Nunes da Silva
- Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | - Kyan James Allahdadi
- Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | - Fabio Tavora
- Messejana Heart and Lung Hospital, Fortaleza, Brazil
| | | | | | - Milena Botelho Pereira Soares
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil; Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil.
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Lala RI, Lungeanu D, Darabantiu D, Pilat L, Puschita M. Galectin-3 as a marker for clinical prognosis and cardiac remodeling in acute heart failure. Herz 2018; 43:146-55. [PMID: 28235980 DOI: 10.1007/s00059-017-4538-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/14/2017] [Accepted: 01/15/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Galectin-3 has been reported as a mediator of heart failure (HF) development and progression. Most studies, however, have been conducted on patients with chronic HF rather than acute HF (AHF). The aim of this study was to confirm galectin-3 as a prognostic marker in subjects with AHF and to investigate its possible relationship with left ventricular (LV) remodeling. METHODS A total of 69 patients hospitalized with a primary diagnosis of AHF were followed up for 18 months. Galectin-3 and echocardiographic parameters were measured at baseline and after 6 months. Survival analysis and exploratory analysis of LV remodeling were performed. RESULTS Patients with high baseline galectin-3 values (>16.5 ng/ml) had a significantly worse survival profile over the 18-month follow-up (log-rank test, p = 0.017), with Cox proportional hazards modeling showing a crude hazard ratio (HR) of 4.66 (95% CI = 1.16-18.67; likelihood-ratio test, p = 0.037) for all-cause mortality. Changes in galectin-3 levels (1 SD increase over 6 months) proved to be a significant explanatory factor for HF hospital re-admission in the short term when compared with quasi-stationary galectin-3 levels: worse Kaplan-Meier survival curves (log-rank test, p = 0.001) and a crude HR of 4.44 (95% CI = 1.76-11.18; likelihood-ratio test, p = 0.004). A significant association was found between the pathological evolution of relative wall thickness, LV end-diastolic diameter, LV end-diastolic volume, and increasing levels of galectin-3 in the short term (Cochran-Mantel-Haenszel test, p < 0.01). CONCLUSION Galectin-3 can predict long-term mortality in patients with AHF. The results of our study suggest a possible relation between left ventricular remodeling and increasing galectin-3 levels.
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Arangalage D, Nguyen V, Robert T, Melissopoulou M, Mathieu T, Estellat C, Codogno I, Huart V, Duval X, Cimadevilla C, Vahanian A, Dehoux M, Messika-Zeitoun D. Determinants and prognostic value of Galectin-3 in patients with aortic valve stenosis. Heart 2016; 102:862-8. [DOI: 10.1136/heartjnl-2015-308873] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/21/2016] [Indexed: 11/04/2022] Open
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