الفهرس 
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Abstract
Summary
eart failure is a large medical and epidemiological
problem. Studies in chronic heart failure indicate that it is
still associated with a high morbidity and mortality (McMurray et
al., 2012). Prognosis of HF is poor and definitive treatment is
challenging (Ho et al., 2012).
Heart failure with normal ejection fraction (HFNEF)
accounts for more than 50% of all heart failure patients and as
the prevalence of HFNEF in the heart failure population rises
by-1% a year (Owan et al., 2006).
Galectin-3 is a soluble β-galactoside-binding lectin. In
response to myocardial insult, Galectin-3 is released by activated
cardiac macrophages and induces fibroblasts proliferation and
deposition of type I collagen in the myocardium and stimulating
matrix production (Kramer, 2013).
There is growing evidence that galectin-3 is directly
involved in the pathophysiology of cardiac injury and progression
to HF, making it a potential diagnostic, prognostic and therapeutic
target (Hrynchyshyn et al., 2013). Recently, galectin 3 was
approved by the US Food and Drug Administration as a new
biomarker for HF risk stratification and has received a Class IIb
recommendation for additive risk stratification in AHA/ACC
guidelines (Yancy et al., 2013).
H
Summary
161
The aim of this work was to study galectin 3 in children
with chronic heart failure and if raised correlate its level to the
severity of chronic heart failure.
This study was performed at the pediatric cardiology clinic
and echocardiography unit, children’s hospital, Ain Shams
University from April 2014 to March 2015 on 45 patients with
chronic heart failure and included two groups.
i. Group І: included 45 patients with chronic heart failure 23
(51.1%) males and 22 (48.9%) females their ages ranged
from 0.2-15 years with a mean age of 7.46±5.73 years.
This group was subdivided into:
Group Іa: Included 22 (48.9%) patients with heart failure
with normal Ejection Fraction with their EF > 50 %
(Masutani et al., 2013) 12 (54.5%) males and 10 (45.5%)
females with a mean age of 8.6±5.2 years.
Group Іb: Included 23 (51.1%) patients with heart failure
with Reduced Ejection Fraction with their EF ≤ 50 %
(Masutani et al., 2013) 11 (47.8%) males and 12(52.2%)
females with a mean age of 5.6±5.6 years.
ii. Group П: Included 45 ages and sex matched healthy
children 23 (51.1%) males and 22 (48.9%) females with a
mean age of 7.47±5.67 years as a control group.
Summary
162
All patients were subjected to the following:
Full history taking laying stress on symptoms of heart failure.
Classification of chronic heart failure according to the
symptom based Modified Ross classification of heart failure
(Ross, 2012).
Thorough clinical examination laying stress on signs of heart
failure.
Laboratory investigations including CBC and serum Na, K
and creatinine.
Calculation of eGFR using Schwartz equation (Schwartz et
al., 2009).
Assessment of serum galectin 3 level using ELISA technique.
Routine 2D echocardiography to delineate cardiac chamber
dimensions and congenital heart defects. M mode
echocardiography to assess the left ventricle dimension and
systolic function. LV mass was calculated as recommended by
the American Society of Echocardiography’s Guidelines (Lang
et al., 2005) from the following formula:
0.8 {1.04[(LVEDD + LV posterior wall thickness + LV
septal wall thickness)3 - LVEDD3]} + 0.6 gm (Devereux et al.,
1986).
Also continuous, pulsed, color Doppler echocardiography
and tissue Doppler imaging to evaluate diastolic function using a
commercially available cardiac ultrasound unite, by using device
Summary
163
model (vivid E9 GE vingmed ultrasound A/S N-3191 Horten
Norway).
No significant difference was found between patients and
control as regards age and sex. But patients group had a
statistically significant decrease in weight, height, BMI and BSA.
No significant difference was found between patients with
HFREF and patients with HFNEF as regards age, sex, weight,
height, BMI and BSA
The patients group was divided according to type of HF
into 22 patients (48.89%) with HFNEF (there EF% ≥50) and 23
patients (51.11%) with HFREF also divided according to etiology
of HF into 15 patients (33.33%) with DCM, 15 patients (33.33%)
with CHD and 15 patients (33.33%) with RHD.
Patients group was classified according to Ross
classification of heart failure in children into 4 classes and
included 12 patients (26.67%) in Class I heart failure, 8 patients
(17.78%) in class II heart failure, 14 patients (31.11%) in class III
heart failure and 11 patients (24.44%) in class IV heart failure.
As regards clinical data, the patients group included 4
patients (8.88%) with hypotension, 7 patients (15.55%) with
tachycardia, 9 patients (20%) with tachypnea, 1 patient (2.22%)
with lower limb edema and 23 patients (31.11%) with tender
hepatomegaly. Blood pressure was statistically significant lower
in patients group than controls while heart rate and respiratory
rate was statistically significant higher in patients group than
controls. No significant difference was found between patients
with HFREF and patients with HFNEF as regards clinical data.
Summary
164
As regards laboratory data, patients had higher serum
creatinine than control and lower eGFR, serum Na, blood
hemoglobin level and TLC than controls while no difference was
found as regard PLT count and serum K. No significant
difference was found between patients with HFREF and
patients with HFNEF as regards serum creatinine, eGFR, TLC,
hemoglobin level, platelets count, serum Na and serum K.
The mean value of serum galectin 3 level among the
controls was (1.52 ± 0.66) ng/ml ranging between (0.6 - 3.5) ng/dl
while the mean value of serum galectin 3 level among the patients
was (9.46 ± 5.43) ng/dl ranging between (3.5 - 30) ng/dl so there
was a highly significant difference between patients and controls.
As regards echocardiographic data, patients show
statistically significant increase in LVEDD, LVESD, EDV,
RVESP, LVM and LVMI of patients compared to controls and
statistically significant decrease in EF% and FS% of patients
compared to controls. A statistically significant increase in
LVEDD, LVESD, EDV and SV was found in patients with
HFREF compared to patients with HFNEF. No significant
difference was found between patients with HFREF and patients
with HFNEF as regards IVSD, LVPWD, LAD, RVESP, LVM
and LVMI.
Patients showed statistically significant increase in E wave,
A wave, E/A ratio E/Em ratio and Em/Am ratio was found in
patients compared to controls while a highly significant decrease
in Em, Am and Sm was found in patients compared to controls. A
statistically significant increase in A wave and E/A ratio was
found in patients with HFNEF compared to patients with HFREF.
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165
A statistically significant decrease in E wave was found in
patients with HFNEF compared to patients with HFREF. A
highly significant increase was found in Em of patients with
HFREF compared to patients with HFNEF. A highly significant
decrease was found in Sm of patients with HFREF compared to
patients with HFNEF. A statistically significant increase in Am,
Em/Am and E/Em ratio was found in patients with HFNEF
compared to patients with HFREF.
Patients with HFNEF had higher serum galectin 3 levels
but did not reach statistical significance. Patients with DCM had
mean value 10.3 ng/ml followed by patients with CHD with a
mean value 9.5 ng/ml followed by patients with RHD with a
mean value 8.57 ng/ml but this did not reach statistical
significance. A statistically significant increase was found in
serum galectin 3 levels of patients not receiving spironolactone
compared to patients receiving spironolactone.
A highly significant difference was found between 4
classes of heart failure as regards mean values of the serum
galectin 3 level. A highly significant increase was found in mean
value of the serum galectin 3 level of patients in class ІІІ versus
patients in class І, patients in class ІV versus patients in class І,
patient in class ІV versus patients in class ІІІ and patient in class
ІV versus patients in class ІІІ. No significant difference was found
in mean values of the serum galectin 3 levels between patients in
class І versus patients in class ІІ and patients in class ІІ versus
patients in class ІІІ. Also, a highly significant positive correlation
was found between serum galectin 3 levels and classes of heart
failure according to Ross classification among patients
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A significant positive correlation was found between serum
galectin 3 levels and age of patients. While no significant
correlation was found between serum galectin 3 levels and body
weight, height, BMI and BSA of patients.
No significant correlation was found between serum
galectin3 and duration of illness, number of hospital admissions,
duration of hospital admissions, number of ICU admissions,
duration of ICU admission, number of drugs and duration of drug
intake in patients. Also, no significant correlation was found
between serum galectin 3 levels and systolic blood pressure,
diastolic blood pressure, respiratory rate and heart rate in patients.
No significant correlation was found between serum
galectin 3 levels and serum creatinine, eGFR, TLC, blood
hemoglobin level, platelets count, serum Na and serum K in
patients.
Galectin 3 showed a significant positive correlation with
LVEDD, LVESD, EDV ESV, RVESP and LVMI of patients and a
significant negative correlation with EF and FS of patients while
no significant correlation was found with, IVSD, LVPWD and
LAD.
As regards diastolic function data, a significant positive
correlation was found between serum galectin 3 levels and E wave,
A wave, E/A ratio, Em, Am, Em/Am and E/Em in patients.
Significant negative correlation was found between serum galectin
3 levels and Sm in patients.
Conclusion
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Conclusion
Serum galectin-3 level was significantly increased in
patients than controls and a cut off value of 3.5 ng/mL can be
used for diagnosis of heart failure. Its level was related to HF
severity, including Ross classification and echocardiographic
findings. Thus it can be used as a marker for heart failure staging
in infants where symptoms are few and vague.
Patients with HFNEF do not show manifestation of systolic
dysfunction, yet the ongoing diastolic dysfunction was associated
by a raised galectin 3 level indicating an ongoing process of
remodeling.
Serum galectin-3 level was increased in patients with
HFNEF than patients with HFREF but this did not reach
statistical significance. This effect might be due to the
administration of spironolactone that blocked the galectin 3
mediated aldosterone induced fibrosis thus the addition of
spironolactone to patients with elevated galectin 3 might decrease
cardiac remodeling.