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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 4  |  Page : 1501-1505

Galectin-3 in children with heart failure secondary to congenital heart diseases


1 Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Pediatrics, Ministry of Health, Shebin El-Kom, Menoufia Governorate, Menoufia, Egypt

Date of Submission19-Dec-2018
Date of Decision23-Jan-2019
Date of Acceptance28-Jan-2019
Date of Web Publication31-Dec-2019

Correspondence Address:
Shimaa T El-Taweel
Shebin El-Kom, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_418_18

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  Abstract 


Objective
The aim was to assess serum level of galectin-3 in children with heart failure (HF) secondary to congenital heart disease (CHD) and correlate it with diagnosis and outcome.
Background
Galectin-3 is an emerging biomarker that has been linked to tissue fibrosis, a hallmark in cardiac remodeling and HF. Galectin-3 can reliably be measured in the circulation to detect early failure.
Patients and methods
This prospective cohort study was conducted at Pediatric Intensive Care Units of Menoufia University Hospital from September 2017 to July 2018. The assessed serum galectin-3 levels in 30 children with CHD with HF were compared with 30 children who had CHD without symptoms of HF and 20 apparently healthy children, used as controls, who visited the pediatric outpatient clinic and were subjected to routine clinical examinations.
Results
The demographic data of the studied groups showed that there was no statistically significant difference among the studied groups regarding sex, age, weight, and height, but there was a statistically significant difference among the studied groups regarding BMI, where P value was 0.03. There was a highly statistically significant difference among the studied groups regarding galectin-3 levels. There was a highly statistically significant correlation between galectin-3 levels and echo finding, i.e., ejection fraction, but there was no statistically significant correlation between galectin-3 and outcome of CHD with or without HF.
Conclusion
Galectin-3 has a promising diagnostic value in pediatric HF.

Keywords: congenital heart disease, galectin-3 in heart failure, galectin-3, heart failure in children, heart failure


How to cite this article:
Khattab AA, Saleh NY, Rizk MS, El-Taweel ST. Galectin-3 in children with heart failure secondary to congenital heart diseases. Menoufia Med J 2019;32:1501-5

How to cite this URL:
Khattab AA, Saleh NY, Rizk MS, El-Taweel ST. Galectin-3 in children with heart failure secondary to congenital heart diseases. Menoufia Med J [serial online] 2019 [cited 2020 Feb 16];32:1501-5. Available from: http://www.mmj.eg.net/text.asp?2019/32/4/1501/274276




  Introduction Top


Heart failure (HF) describes a state in which a cardiac problem leads to insufficient oxygen delivery to the peripheral organs. Clinically, HF is manifested as dyspnea or fatigue owing to the functional or structural impairment of ventricular filling or ejection of blood [1].

Congenital heart disease (CHD) is a structural and functional heart disease, which is present at birth. It is the most common birth defect, affecting ∼1% of all live born infants [2].

Three putative routes have been proposed for the development of HF in CHD: rare monogenetic entities that cause both CHD and HF, severe CHD in which acquired hemodynamic effects of CHD or surgery result in HF, and a combined effect of complex genetics and acquired stressors [3].

Galectin-3 (gal-3) is a carbohydrate-binding protein produced by activated macrophages, generated intracellularly in both the nucleus and cytoplasm and at the cell surface [4]. Galectin-3 is an emerging biomarker that has been linked to tissue fibrosis and is the hallmark in cardiac remodeling and HF, which can reliably be measured in the circulation, and several recent studies have shown the diagnostic value of galectin-3 in acute and chronic HF and its potential utility in the general population [5].

The aim of this study was to assess the value of galectin-3 measurements in pediatric HF.


  Patients and Methods Top


The study was performed at Pediatric Intensive Care Units of Menoufia University Hospital from September 2017 to July 2018. It was approved by the local ethics committee. A written informed consent for children was obtained from their parents before inclusion. In this prospective study, 30 children who were aged more than 1 month to 5 years old and had CHD with HF confirmed with low ejection fraction (EF%) as group A were compared with both 30 children with CHD without HF (group B) and 20 healthy children (group C), used as controls, who were subjected to routine clinical examinations. The studied groups were matched for age and sex. However, children with chronic abnormalities, multiple congenital anomalies, HF secondary cardiomyopathy, and HF secondary to rheumatic heart diseases were excluded.

All patients were subjected to full history taking (age, sex, residence, consanguinity of parents, and duration of symptoms) and clinical examination, including general examination (HR, RR, T, BP, and pulse), anthropometric measurements [weight (kg), height (cm), and BMI], local examination (CVS, respiratory, and neurological), Ross scores, plain chest radiography and heart posterior anterior view, ECG, and echocardiography.

For most of the laboratory investigations, including blood picture (complete blood count), liver function tests, kidney function tests, serum electrolytes, cardiac troponin I (cTnI), and galectin-3, approximately 5 ml of venous blood samples was collected, where 2 ml was collected in EDTA tubes for complete blood count and 3 ml was stored for 2 h after collection at room temperature, and centrifugation at 3000 rpm for 10 min. Blood gas analyses were done by using a special heparinized blood syringe. Galectin-3 ELISA test kits were obtained from Sun Red Manufacturer (Shanghai China). Instructions inside the kit were followed for evaluation of galectin-3 using monoclonal antibody against human galectin-3 as the first antibody.

Statistical analysis

Values were expressed as means and SD or counts and percentages as appropriate. The primary outcome was HF (Ross class II–IV) versus no HF (Ross class I). To assess the association between galectin-3 levels and EF% in patients with clinical HF (EF <50%), a binary variable was created. Spearman's correlation coefficients were calculated. Data were collected, tabulated, and statistically analyzed using a personal computer with statistical package for social sciences (SPSS; SPSS Inc., Chicago, Illinois, USA) version 20 where the following statistics were applied. Two types of statistics were done: descriptive statistics, for example, number, percentage, mean, and SD, and analytic statistics, for example, χ2-test, Student's t-test, Kruskal–Wallis test (K), one-way analysis of variance test (F), and Mann–Whitney test (U). P value less than or equal to 0.05 was considered to be statistically significant, and P value less than or equal to 0.001 to be highly statistically significant.


  Results Top


There were no statistically significant differences among the studied groups regarding sex, age, weight, and height, but there was a statistically significant difference among the studied groups regarding BMI, where P value was 0.03. Moreover, there were highly statistical significant differences among the three groups regarding heart rate and respiratory rate, where P value was less than or equal to 0.001, and there was a highly statistically significant difference between the two groups A and B regarding EF, where P value was less than or equal to 0.001 [Table 1].
Table 1: Clinicodemographic data and laboratory investigations of the studied groups

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There was a highly statistically significant difference among the studied groups regarding total leukocyte count and serum creatinine, where P value was less than or equal to 0.001 [Table 1].

The was a highly significant difference in the serum level of galectin-3 among the studied groups (mean: 20.3 ± 5.3 ng/ml in group A, 6.3 ± 4.4 in group B, and 3.08 ± 1.5 in controls), where P value was less than or equal to 0.001. Moreover, there was a highly significant difference in the troponin levels among the studied groups (mean: 0.304 ± 0.523 ng/ml in group A, 0.201 ± 0.39 in group B, and 0.017 ± 0.02 in controls), where P value was less than or equal to 0.001 [Table 2].
Table 2: Galectin-3 and troponin levels in studied groups

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There was a highly statistically significant correlation between galectin-3 and total leukocyte count, where P value was 0.01, and no statistically significant correlation was found between galectin-3 and aspartate transaminase, alanine transaminase, and serum creatinine [Table 3].
Table 3: Correlation between galectin-3 and laboratory investigations

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There was no statistically significant correlation between galectin-3 and outcome of CHD with or without HF [Table 4].
Table 4: Correlation between galectin-3 and outcome of congenital heart disease

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The overall outcome percentage of CHD was 23.3% died and 76.7% improved; in group A, 20% died and 30% improved, whereas in group B 3.3% died and 46.7% improved [Figure 1].
Figure 1: Outcome of patients with congenital heart disease.

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A highly statistically significant correlation was founded between galectin-3 levels and echo finding, i.e., EF%, with P value was less than or equal to 0.001 [Figure 2].
Figure 2: Correlation between galectin-3 and ejection fraction%.

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  Discussion Top


HF results when cardiac output is insufficient to meet the metabolic demands of the body. Over time, decreased cardiac output leads to a cascade of compensatory responses that are aimed directly or indirectly at restoring normal perfusion to the body's organs and tissues [6]. The largest HF burden is seen in children born with congenital malformations. It has been estimated that 15–25% of children who have structural heart disease develop HF [7]. Galectin-3 has emerged as a biomarker of inflammation and fibrosis in HF. Tissue fibrosis is a central pathway in the progression of HF. Cardiac fibrosis impairs ventricular function and contributes to both systolic and diastolic pressure dysfunctions. Studies have shown that galectin-3 plays a key role in tissue fibrosis and ventricular remodeling. Galectin-3 is expressed at higher levels in cardiac fibroblasts [8]. Our study agrees with the study by El-Amrousy et al. [9]. which found that there was no significant difference between HF group and control group in age, sex, or body weight. There were statistically significant differences among the studied groups regarding BMI in our study, which agrees with Mohammed et al. [10], and Rubia and Kher [11] who demonstrated that children with CHD had significant evidence of growth impairment for both weight and length for age (BMI). Schwartz et al. [12] found that decreased energy intake, malabsorption, and increased basal energy requirements may all lead to compromised growth and underweight in children with CHD. This study found that there were highly statistically significant differences among the three groups regarding heart rate and respiratory rate. This agrees with the studies by Masatsugu and Hiroshi [13] and El-Amrousy et al. [9]. These studies found that heart rate and respiratory rate are mainly regulated by autonomic nerve activities and increased with attenuated vagal nerve activity or enhanced sympathetic nerve activity in patients with HF. Our study found a significant increase in total leukocyte count because increased concentration of leukocytes is a classical marker of acute or chronic systemic inflammation and a risk marker for cardiovascular disease. The study by Engström et al. [14] showed that moderately increased leukocyte concentrations are associated with incidence of hospitalizations owing to HF. There was significant increase in creatinine level in patient groups in our study. This was in line with the study by Shlipak et al. [15], which have determined the importance of renal function in HF and found that increased creatinine levels during hospitalization are a marker of poor cardiac output leading to diminished renal blood flow and reduced ability to tolerate inpatient HF treatment. Thus, the change in creatinine is more likely to be indicative of the severity of cardiac dysfunction rather than of acute renal damage. The outcome percentage of CHD with or without HF was in agreement with Moussa et al. [16] and Zomer et al. [17]. These studies found that HF is a severe event in CHD associated with a high mortality rate (20%) and found mortality was fivefold higher in patients with HF in CHD compared with patients without HF in CHD. Moreover, HF-related hospitalization was associated with a strong increase in the risk of cardiovascular events. In this study, we found the significance of gal-3 and cTnI between studied groups, which were in line with Hanan Mahmoud et al. [18] Their study found gal-3 and cTnI plasma levels were statistically significantly higher in subjects with HF compared with control, with mean gal-3 of 18.40 ± 11.5 ng/ml among patients with HF and 5.75 ± 1.427 ng/ml among control group (P < 0.001). Moreover, mean cTnI was 0.429 ± 0.630 ng/ml among patients with HF and 0.019 ± 0.0544 ng/ml among control group (P = 0.004). The study by Mohammed et al. [19] revealed significantly elevated serum galectin-3 levels in patients with HF compared with controls, with P value less than 0.001. This can be explained by the fact that myocardial injury generates inflammatory signals that recruit activated macrophages to the myocardium and that mediators such as osteopontin stimulate these macrophages to secrete galectin-3.

In this study, there was a positively correlation between galectin-3 and leukocytic count. This agreed with the study by Tsai et al. [20], which compared the circulating galectin-3 level and white blood cells count, an index of inflammation, and found that these were significantly higher in patients with HF, an indirect index of a higher degree of inflammation. This was significantly more frequently seen in patients with high galectin-3 than in those with low galectin-3, so there seems to be a significant positive correlation between circulating level of galectin-3 and white blood cells count.

The study by Hamdy et al. [21] showed a positive correlation between level of galectin-3 and EF (P < 0.000), which was similar to the present study. Similarly, the study by Iqbal et al. [22] showed that there was significant evidence of cardiac remodeling and significantly worsened EF detected by echocardiography between cardiac patients and healthy children. They considered that the clinical and cardiac structural correlations with galectin-3 in their study provide indirect evidence supporting a potential role for galectin-3 in the pathogenesis of cardiac remodeling in HF.


  Conclusion Top


Galectin-3 has emerged as a biomarker of inflammation and fibrosis in HF and is elevated in pediatric patients with suspected or known HF secondary to CHDs along with troponin I levels.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Masatsugu H, Hiroshi O. Heart rate as a target of treatment of chronic heart failure. J Cardiol 2012; 60:86–90.  Back to cited text no. 13
    
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Engström G, Melander O, Hedblad B. Leukocyte count and incidence of hospitalizations due to heart failure. Circ Heart Fail 2009; 2:217–222.  Back to cited text no. 14
    
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