The Predictive Value of Circulating Gal-3 for New Stroke Events in Paroxysmal Atrial Fibrillation Patients Despite Oral Anticoagulation Medications

Abstract

Background

CHA2DS2-VASc is used to assess the risk of stroke in patients with atrial fibrillation (AF) and guide anticoagulant treatment decisions, but it has limitations in accurately predicting stroke risk in individual patients. The objective of this study is to conduct a cohort study by assessing preoperative levels of Gal-3 in paroxysmal AF patients, aiming to observe its correlation with the subsequent incidence of stroke events.

Method

This study enrolled 197 patients with nonvalvular paroxysmal AF. Blood samples were taken to test Gal-3 levels. All patients were followed up for 4 years after admission.

Results

Compared to the nonstroke cases, serum levels of Gal-3 were markedly elevated in stroke cases (7.08 [IQR, 4.60–10.96] vs. 17.34 [IQR, 8.28–20.31], p < 0.001). Gal-3 yields a superior AUC (0.748, with a 95%CI of 0.681–0.807) compared to other classical stroke indices, such as BNP, CHA2DS2-Vas score, and TNI. Remarkably, the Gal-3 index exhibited a superior predictive capacity, yielding a significant incremental predictive value that surpassed the conventional risk factors (CHA2DS2-VASc score) for stroke events, as evidenced by an IDI of 16.4% (p < 0.001) and an NRI of 34.7% (p = 0.002).

Conclusion

The presence of Gal-3 is an independent risk factor for stroke in patients with AF. Elevated levels of Gal-3 have the potential to serve as a valuable biomarker for identifying incident strokes in AF patients. Furthermore, incorporating the assessment of Gal-3 levels into the conventional CHA2DS2-VASc score could significantly enhance its predictive accuracy for stroke in AF patients.