ABC | Volume 114, Nº4, April 2020

Original Article Fernandes et al. Galectin-3 in pericardial constriction Arq Bras Cardiol. 2020; 114(4):683-689 Table 4 – Histopathologic analysis and galectin-3 Mild Severe Fibrosis n (%) 2 (9.5) 19 (90.5) Gal-3 19.7 [14.2-25.2] 14.8 [9.4-17.2] Calcification n (%) 9 (42.9) 12 (57.1) Gal-3 16.1 [11.9-20.3] 14.1 [9.5-16.2] Inflammation n (%) 16 (76.2) 5 (23.8) Gal-3 14.5 [10.5-16.9] 16.1 [9.3-25.2] Continuous variables are presented as median and interquartile range [IQR], categorical data are presented as percentage. No statistically significant difference was found between the groups. observe an increase in galectin levels and myocardial delayed enhancement evaluated by CMR and histological analysis. Cardiopulmonary testing is the most useful tool to objectively assess the exercise capacity of patients with systolic and diastolic heart failure. 6 The test allows assessment of prognosis, efficacy of treatment, and selection for heart transplantation. Moreover, cardiopulmonary testing plays an important role in the prescription of exercises and rehabilitation programs. Our patients improved peak VO 2 and V E /VCO 2 slope which are two independent predictors of mortality in heart failure patients with systolic or diastolic dysfunction. 13,14 Also, an increase in peak VO 2 is associated with lower hospital readmissions in heart failure patients, demonstrating the importance of pericardiectomy for these patients. 15 On the other hand, although numerous studies have evaluated the impact of pericardiectomy on the functional class of patients with CCP, most of them were retrospective case series. 10,12 Moreover, clinical assessment based on NYHA classification is imprecise and subjective. Some patients do not experience recovery in their functional capacity and NYHA functional class. The associations between Gal-3 levels and exercise intolerance after pericardiectomy suggest the possible role of Gal-3 in the pathophysiology of constrictive pericarditis. This hypothesis should be tested in longer follow-up studies. The finding of Gal-3 as a predictor of improvement in functional capacity is relevant, because it suggests that benefits of pericardiectomy appear to be lower in patients with higher levels of Gal-3. Conclusion Gal-3 levels were normal in patients with CCP and did not correlate with morphological and functional measures. The associations between Gal-3 levels and exercise intolerance after pericardiectomy suggest the possible role of Gal-3 in the prognostic prediction after pericardiectomy. Limitations The sample consisted of young patients with a predominance of idiopathic etiology in a tertiary cardiology center, which may represent selection bias and limit the external validity of the results. We had only a single time point measure of Gal‑3, and therefore we did not assess dynamic changes in this biomarker over time. Acknowledgment The authors acknowledge bioMerieux Inc., France, for the Galectin-3 kit donation. Author contributions Conception and design of the research AND Analysis and interpretation of the data: Fernandes F, Melo DTP; Acquisition of data: Fernandes F, Melo DTP, Sayegh ALC, Souza FR; Statistical analysis: Sabino EC,MoreiraCHV;Obtaining financing: Fernandes F;Writing of themanuscript: Fernandes F, MeloDTP, Ramires FJA, Benvenutti LA, Hotta VT, Sayegh ALC, Souza FR, Dias RR; Critical revision of the manuscript for intellectual content: Fernandes F, Melo DTP, Ramires FJA, Sabino EC, Moreira CHV, Benvenutti LA, Hotta VT, Sayegh ALC, Souza FR, Dias RR, Mady C. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding This study was funded by FAPESP. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Hospital das Clínicas da FMUSP under the protocol number 2002.007. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 688