Background: Galectin-3 (Gal-3) – biomarker of fibrosis is increased in patients with atrial fibrillation (AFib) and metabolic syndrome (MetS). We propose that Gal-3 can impact on progression of the arrhythmia. Objective of the study was to evaluate the role of Gal-3 in predicting the effect of antiarrhythmic drug therapy in patients with AFib and MetS.
Methods: 764 AFib patients hospitalized in cardiology department (2016-2017 years) were examined. 180 patients with MetS (IDF, 2005) and paroxysmal (n=100) or persistent (n=80) AFib were included in prospective study. Groups did not differ significantly by gender, age, eGFR (p>0,05), volumes left and right atrium. The examination includes: medical history, anthropometry, echocardiography, serum Gal-3 (ELISA). Patients were taking antiarrhythmic drugs: amiodarone (32%), beta-blockers (42%), sotalol (12%), propafenone (14%) during 16,7±6,9 months. After that we analyzed the clinical data and the effectiveness of antiarrhythmic drug therapy, which is considered effective if there were no reported paroxysms of AFib during follow-up.
Results: Gal-3 in patients with persistent AFib was higher than in patients with paroxysmal AFib (1,02 [0,52;3,14] and 0,54 [0,41;1,31] ng/ml, ?=0,03). In patients with 1-2 paroxysms in month Gal-3 was higher than in patients with 1-2 paroxysms in year (1,31 [0,92;4,21] and 0,53 [0,41;0,72] ng/ml, ?<0,001). Gal-3 in patients with recurrent paroxysms of AFib and without the effect of antiarrhythmic therapy was higher than in patients without recurrent paroxysms of AFib irrespective of antiarrhythmic drug (1,31 [0,75,2,49] and 0,50 [0,41;0,72] ng/ml, p<0,001). The multivariate regression analysis demonstrated that Gal-3 is an independent predictor of non-effective antiarrhythmic drug therapy of AFib (OR=2,38, 95% CI 1,12-5,04, p=0,024). In patients with AFib and MetS who had serum Gal-3 above 0,77 ng/ml (cut-off point on ROC-curve) the risk of non-effective antiarrhythmic therapy was in 3,6 fold higher during follow-up the study (RR=3,6, 95% CI 1,6-7,9, p=0,002).
Conclusions: The level of serum galectin-3 in patients with persistent atrial fibrillation is higher than in patients with paroxysmal. Patients with higher level of galectin-3 have a higher risk of non-effective antiarrhythmic drug therapy, that may be an additional indication for surgical treatment.