N-terminal pro BNP and galectin-3 are prognostic biomarkers of acute heart failure in sub-Saharan Africa: lessons from the BAHEF trial

Aims: The relationship between N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and galectin-3 and outcomes has not been studied in African patients with acute heart failure (AHF). The current analysis sought to describe the association between plasma levels of NT-pro-BNP and galectin-3 and cardiovascular (CV) death or heart failure (HF) hospitalization, as well as their associations with symptoms and echocardiography markers of left and right ventricular remodelling among AHF patientsv in sub-Saharan Africa.

Methods and results: In a subset of 80 patients with complete data in a study assessing the effects of hydralazine and nitrates in patients with AHF (BAHEF trial; NCT01822808), NT-pro-BNP and galectin-3 analyses were performed, and the association with various characteristics and outcome measures assessed. The mean age of the patients for whom the aforementioned biomarkers were measured was 52.6 years, with 52.5% women. Galectin-3 at baseline predicted changes (Week 24 to baseline) in left ventricular ejection fraction, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, and tricuspid annular plane systolic excursion. Biomarkers and their changes were not associated with changes in 6 min walk test at 24 weeks. Baseline galectin-3 and change in NT-pro-BNP were associated with improvements in dyspnoea at 24 weeks. Nine patients had an HF readmission or died of CV causes through 24 weeks (11.6%). Both biomarkers at baseline predicted combined CV death or HF hospitalization through Week 24 (P-values = 0.0328 and 0.0001, respectively).

Conclusions: In a cohort of patients with AHF from sub-Saharan Africa, NT-pro-BNP and galectin-3 at baseline and their changes were associated with some changes in dyspnoea, echocardiographic remodelling, and CV death or HF hospitalization through Week 24. These tests have potential of being used for risk stratification of AHF patients in sub-Saharan Africa where resources are scarce.