Cystatin C and galectin-3 as therapeutic targets in heart failure

We have carefully read the Letter to the Editor by Pérez-Calvo and colleagues, regarding our article ‘Left atrial volume index in patients with heart failure and severely impaired left ventricular systolic function: the role of established echocardiographic parameters, circulating cystatin C and galectin-3’ and we thank the authors for offering important issues for further discussion.1 The authors strongly disagree with our proposal that cystatin C (CysC) and galectin-3 (Gal-3) may be novel therapeutic targets in heart failure (HF), as we suggest in our recent article published in the journal.2 In this study we showed that left atrial volume index was correlated with mitral regurgitant volume, plasma CysC and right ventricular systolic pressure in HF with severely impaired ejection fraction (HFrEF). Moreover, CysC was positively associated with circulating Gal-3, giving new insights to heart and kidney cross-talk. This indicates that multiple processes are involved in fibrosis, as both proteins are responsible for extracellular matrix (ECM) modulation.3,