Serum Galectin 3 And Soluble ST2 As Predictors Of Heart Failure Hospitalization In Patients With Reduced Ejection Fraction

Background: Heart failure with reduced ejection fraction (HFrEF) remains a leading cause of hospitalization. Fibrosis- and strain-related biomarkers, such as Galectin-3 and soluble ST2 (sST2), may improve risk stratification. Objective: To evaluate the predictive value of baseline serum Galectin-3 and sST2 levels for heart failure–related hospitalization over 24 months in patients with HFrEF. Methods: In this prospective cohort study of 1,000 patients with chronic HFrEF (mean age ~65 years, mean EF ~30%), baseline Galectin-3 and sST2 levels were assessed. Multivariable logistic regression identified independent predictors. Kaplan–Meier analysis compared hospitalization-free survival by biomarker level (median split), and ROC analysis assessed model discrimination. Results: Hospitalization occurred in 364 patients (36.4%). Both sST2 (β = +0.042, p < 0.001) and Galectin-3 (β = +0.028, p = 0.035) were independent predictors of hospitalization. Higher ejection fraction was protective (β = −0.056, p < 0.001); age and renal function were not significant. sST2 consistently predicted shorter hospitalization-free survival (log-rank p < 0.0001), while Galectin-3 showed a non-significant trend (p = 0.0752). Adding both biomarkers to a clinical model improved AUC from 0.578 to 0.647 and pseudo-R² from 0.016 to 0.048. Conclusion: Both sST2 and Galectin-3 independently predict heart failure hospitalization in patients with HFrEF. sST2 showed stronger prognostic power, but Galectin-3 added incremental value. Incorporating these biomarkers enhances risk stratification beyond conventional clinical variables.