Galectin-3 in heart failure pathology--"another brick in the wall"?

Heart failure is a disease affecting millions of patients each year, and is responsible for burdening the world with high mortality rates. More concerns come from its numerous hospital readmissions (with an estimated number of 2.6 million per year which makes it one of the leading diseases responsible for national healthcare expenditures). Despite drastic improvement of therapies in recent years, heart failure remains a progressive disease. Thus, more attention has been given to finding potential biomarkers involved in the pathological mechanisms of this disease that would potentially lead to faster diagnosis and improved prognosis. One of the emerging biomarkers that has just recently come into the spotlight is galectin-3. It was associated in recent clinical trials with both the progression and severity of heart failure. Ventricular remodelling and myocardial fibrosis are essential for heart failure development and are linked to poor outcomes. An ever-growing body of evidence places galectin-3 as an important link between inflammation and fibrosis, which play a prominent role in cardiac remodelling.This review sums up the most relevant experimental and clinical studies about galectin-3 and its potential prognostic value in heart failure. The article also provides a better understanding of this molecule's involvement in heart failure pathology by modulating cardiac fibrosis. It also weighs whether the available data on galectin-3 are consistent enough to reduce readmissions and mortality while improving diagnosis and future therapies for heart failure, versus the possibility that it is simply"another brick in the wall?"

Successive Waves of the COVID-19 Pandemic Had an Increasing Impact on Chronic Cardiovascular Patients in a Western Region of Romania.

Three years since the COVID-19 pandemic started, there is still little information about patients with chronic medical conditions, such as cardiovascular diseases (CVDs), who become infected with SARS-CoV-2. A retrospective analysis was performed to evaluate the impact of the COVID-19 pandemic on patients with cardiovascular comorbidities hospitalized with positive RT-PCR results for SARS-CoV-2 during the highest peaks of the first three pandemic waves: April 2020, October 2020, and November 2021. The primary outcome was in-hospital mortality; the secondary outcomes were length of hospitalization and required mechanical ventilation to assess the disease severity. Data were extracted from the hospital electronic database system: 680 eligible cases were identified out of 2919 patients. Mortality was the highest in wave 3 (31.9%) compared to the previous waves (13.6% and 25.8%). Hospitalization was also significantly longer in wave 3 (11.58 ± 5.34 vs. 8.94 ± 4.74 and 10.19 ± 5.06; p < 0.001), and so was the need for mechanical ventilation (21.7% vs. 8.2% and 9%; p < 0.001). Older age and male gender were confirmed as highly significant predictors of unfavorable outcomes. Ischemic heart disease worsened the odds of patients' survival irrespective of the three pandemic waves (Breslow-Day test, p = 0.387), with a marginally significant Mantel-Haenszel common estimate for risk: OR = 1.604, 95% (0.996; 2.586). The significantly worse outcomes in wave 3 could have been influenced by a combination of factors: the low percentage of vaccinations in Romanian population, the more virulent delta strain, and pandemic attrition in the care provided to these patients with chronic CVDs.

The chronic coronary syndrome-Heart failure roundabout: A multimodality imaging workflow approach.

Heart failure (HF) is a complex syndrome of considerable burden with high mortality and hospitalization rates. Approximately two-thirds of patients with HF have ischemic etiology, which makes crucial the identification of relevant coronary artery disease (CAD). Moreover, patients with chronic coronary syndrome (CCS) can first show signs of dyspnea and left ventricular (LV) dysfunction. If establishing a diagnosis of HF and consequent management is clear enough, it will not be the same when it comes to recommendations for etiology assessment. Ischemic heart disease is the most studied disease by cardiac multimodality imaging with excellent diagnostic performance. Based on this aspect, the high prevalence of CAD, the worst outcome-HF patients should undergo a diagnostic work-up using these multimodality imaging techniques. The aim of this mini-review is to provide insights on multimodality imaging for diagnosing CCS in patients with new onset of HF and propose a diagnostic work-up based on current international studies and guidelines.

Acute kidney injury: a clinical issue in hospitalized patients with heart failure with mid-range ejection fraction.

INTRODUCTION Acute kidney injury (AKI) during hospitalization is associated with increased mortality in patients with acute heart failure (AHF). In 2016, the European Society of Cardiology introduced the category of heart failure (HF) with mid­range ventricular ejection fraction (HFmrEF) as a distinct category from HF with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). OBJECTIVES The aim of this study was to evaluate in­hospital mortality risk associated with AKI in patients with AHF, with a focus on the HFmrEF group. PATIENTS AND METHODS A total of 365 health records of patients with a primary diagnosis of acute decompensated heart failure (ADHF) were reviewed. AKI was defined according to Acute Kidney Injury Network criteria. HF was diagnosed based on Framingham criteria. Patients with ADHF were evaluated as 3 separate groups, based on ventricular ejection fraction: HFpEF (≥50%), HFmrEF (40%-49%), and HFrEF (<40%). Risk and survival analyses were conducted on de­identified data. RESULTS The AKI­associated in­hospital mortality odds ratios for HFmrEF and HFrEF groups were 4.55 (95% CI, 1.46-14.18) and 2.59 (95% CI, 1.05-6.41), respectively, with a highly significant difference between the groups (P = 0.002; Mantel-Haenszel test). The hazard ratios in the Cox proportional hazards model were 4.79 (95% CI, 1.54-14.96) and 2.94 (95% CI, 1.27-6.80) for HFmrEF and HFrEF groups, respectively. CONCLUSIONS AKI was associated with a higher risk of mortality in patients with HFmrEF when compared with those with HFrEF, suggesting a stronger prognostic impact of AKI in patients with HFmrEF.