Plasma Galectin-3 as a Predictor of Cardiac Dysfunction in Patients Undergoing Doxorubicin Chemotherapy: A Prospective Cohort Study.

BACKGROUND

Doxorubicin is widely used in chemotherapy in oncology. However, it is associated with dose-dependent cardiotoxicity. Thus, early detection of cardiac dysfunction is crucial to preventing heart failure. This study aimed to evaluate plasma Galectin-3 levels, a biomarker of fibrosis and inflammation, as a predictive biomarker of cardiac dysfunction in cancer patients receiving doxorubicin chemotherapy.

METHODS

This observational prospective cohort study was conducted from June 2024 to February 2025 at the Integrated Cardiac Service of Cipto Mangunkusumo National General Hospital (RSCM) and Dharmais Cancer Hospital in Jakarta. Fifty-five patients completed plasma Galectin-3 and echocardiographic assessments at three time points: pre-chemotherapy, post-chemotherapy cycle 2, and post-cycle 4. Cardiac dysfunction was defined by a decrease in LVEF ≥ 10% or a GLS reduction ≥ 15%.

RESULTS

No cardiac dysfunction was observed pre-chemotherapy, but 34.5% and 50.9% of patients developed dysfunction after cycles 2 and 4, respectively. Galectin-3 levels increased significantly post-cycle 4 (mean: 46.89 ± 18.34 ng/mL; p < 0.05). Receiver operating characteristic analysis showed that post-cycle 4 Galectin-3 levels predicted cardiac dysfunction with an area under the curve of 0.767 (95% CI: 0.638-0.897; p = 0.001), 92.9% sensitivity, and 59.3% specificity at a cut-off of ≥ 37.28 ng/mL. Significant correlations were observed between Galectin-3 and GLS (r = 0.54; p = 0.00) but not LVEF.

CONCLUSION

Plasma Galectin-3 levels, particularly after chemotherapy cycle 4, are sensitive biomarkers for detecting cardiac dysfunction in patients receiving doxorubicin. Integrating Galectin-3 with GLS may provide better detection of subclinical cardiotoxicity. Additionally, monitoring Galectin-3 levels may help identify high-risk patients requiring cardioprotective strategies.