e58 Correspondence Dr Januzzi raises several interesting points regarding galectin-3 lev- els after acute myocardial infarction. We found that galectin-3 increased modestly but significantly (by ≈12%) between baseline (≈day 2) and 24 weeks. 1 Serial measurement of galectin-3 in healthy volunteers suggests a reference change value of the order of 61% for galectin-3. 2 A recent analysis of serial galectin-3 levels in 2 chronic heart failure trials sug- gests, however, that a rise in galectin-3 of only ≥15% for 3 to 6 months confers an increased risk of adverse outcomes. 3 It is perhaps possible that smaller fluctuations of galectin-3 in the setting of profibrotic disease states (such as acute myocardial infarction and chronic heart failure) are pathophysiologically relevant. It is also feasible that plasma galectin-3 concentrations may not correlate directly with tissue levels; myocardial galectin-3 content may be significantly in excess of circulating galectin-3. We found that galectin-3 concentrations increased significantly (by ≈14%) in patients treated with eplerenone in our study. Further analy- sis, as requested by Dr Januzzi, revealed no effect of eplerenone on remodeling, whether baseline galectin-3 levels were low (<median) or high (≥median). We agree that the rise in galectin-3 in eplerenone- treated patients is at odds with conventional wisdom, which would predict a decrease in galectin-3 with the use of a mineralocorticoid receptor antagonist. Although this may simply relate to our trial design—it was powered for cardiac MRI end points—a rise in galec- tin-3 in those receiving mineralocorticoid receptor antagonists was also seen in patients enrolled in the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA). Whether the antifibrotic effects of mineralocorticoid receptor antagonists trigger feedback upregulation of galectin-3 (and if so, by what mechanism), whether galectin-3 rises in response to mineralocorticoid receptor antagonist–induced renal dysfunction, or whether there is any relationship at all between galec- tin-3 and the aldosterone pathway remains unclear and is the focus of ongoing study. Galectin-3 is undoubtedly a risk marker in patients with heart failure; whether it represents a modifiable therapeutic target to improve outcome and reduce remodeling in both acute myocardial infarction and chronic heart failure remains unknown. Disclosures None. Robin A.P. Weir, MD Cardiology Department Hairmyres Hospital Lanarkshire, Scotland, UK Colin J. Petrie, MBChB C. Aengus Murphy, MD Cardiology Department Monklands Hospital Lanarkshire, Scotland, UK Suzanne Clements, BSc Cardiology Department Hairmyres Hospital Lanarkshire, Scotland, UK Tracey Steedman, BSc Cardiology Department Western Infirmary Glasgow, Scotland, UK Ashley M. Miller, PhD Iain B. McInnes, PhD Division of Immunology, Infection, and Inflammation Glasgow Biomedical Research Centre University of Glasgow Scotland, UK Iain B. Squire, MD Leong L. Ng, MD Department of Cardiovascular Sciences Leicester Royal Infirmary Leicester, UK and Leicester National Institute for Health Research Cardiovascular Biomedical Research Unit Leicester, UK Henry J. Dargie, MBChB Cardiology Department Western Infirmary Glasgow, Scotland, UK John J.V. McMurray, MD BHF Cardiovascular Research Centre University of Glasgow Scotland, UK References 1. Weir RA, Petrie CJ, Murphy CA, Clements S, Steedman T, Miller AM, McInnes IB, Squire IB, Ng LL, Dargie HJ, McMurray JJ. Galectin-3 and cardiac function in survivors of acute myocardial infarction. Circ Heart Fail. 2013;6:492–498. 2. Wu AH, Wians F, Jaffe A. Biological variation of galectin-3 and soluble ST2 for chronic heart failure: Implications on interpretation of test results. Am Heart J. 2013; 165: 995–999. 3. van der Velde AR, Gullestad L, Ueland T, Aukrust P, Guo Y, Adourian A, Muntendam P, van Veldhuisen DJ, de Boer RA. Prognostic value of changes in galectin-3 levels over time in patients with heart failure. Circ Heart Fail. 2013;6:219–226. (Circ Heart Fail. 2013;6:e58.) © 2013 American Heart Association, Inc. Circ Heart Fail is available at http://circheartfailure.ahajournals.org DOI: 10.1161/CIRCHEARTFAILURE.113.000382 Response to Letter Regarding Article, “Galectin-3 and Cardiac Function in Survivors of Acute Myocardial Infarction” Downloaded from http://ahajournals.org by on May 30, 2020