Galectin-3 and the Right Side of Heart Echocardiographic Changes in COVID-19 Patients

Abstract

Background: Existing literature on COVID-19 infection, however, has not thoroughly investigated the combined use of Galectin-3 with echocardiographic parameters to assess cardiovascular complications in COVID-19. Objectives: To evaluate the relationship between right-heart echocardiographic changes and serum Galectin-3 (Gal-3) levels in hospitalized patients during different phases of COVID-19 infection. Methods: A total of 86 hospitalized patients of both sexes were enrolled and divided into four groups according to disease severity and phase: (i) Group I: Patients with moderately expressed symptoms (within 1 week of symptom onset) — 21 patients; (ii) Group II: Patients with severe symptoms (weeks 2–3 after symptom onset) — 20 patients; (iii) Group III: Patients in the critical phase — 20 patients; (iv) Group IV: Post-COVID-19 patients — 25 patients. All patients underwent standard laboratory evaluation at admission, including measurement of Galectin-3 using an ELISA kit (Human Galectin-3 "SUNLONG"), and transthoracic echocardiography performed with a GE Healthcare Vivid S5 CV ultrasound system, in accordance with COVID-19 clinical guidelines. Results: Serum Galectin-3 levels and echocardiographic parameters reflected the extent of cardiovascular involvement in relation to COVID-19 severity. COVID- 19 was associated with vascular injury and right-heart remodeling, manifested by right ventricular (RV) dilation, right atrial (RA) enlargement, decreased TAPSE values, and increased pulmonary artery systolic pressure (PASP), indicating right-ventricular dysfunction and elevated pulmonary pressures. In the early acute phase among moderately ill patients, Gal-3 demonstrated positive correlations with RV size, RA size, tricuspid regurgitation rate (TRR), and RV function parameters. In severely ill patients, Gal-3 lost its association with RV structural changes, while maintaining correlations with RA size, TRR, and RV functional indices, and showed a significant association with PASP elevation. Despite markedly elevated Gal-3 levels in critically ill patients—reflecting disease severity—no significant correlations were observed between Gal-3 and right-heart structural parameters. In post-COVID-19 patients, Gal-3 appeared to play a different role, acting as an indicator of residual right-heart structural and functional alterations, as demonstrated by its correlation with RA size, TRR, and PASP. Conclusions: Changes in Galectin-3 levels and echocardiographic parameters, as well as their interrelationships, reflect right-heart involvement, disease severity, and prognosis in COVID-19 patients. The pattern of correlation between Gal-3 and right-heart echocardiographic parameters varies across different phases of COVID-19, suggesting a potential role of Gal-3 in cardiac structural remodeling.