LAUSR

To the Editor Prediction of future ventricular tachyarrhythmia is challenging. Makimoto et al. demonstrated that an elevated circulating galectin-3 level was associated with future ventricular arrhythmic events and decompensated heart failure, regardless of a history of ventricular arrhythmias (1). Several concerns have been raised. The initial concern is the implanted devices. Patients with implantable cardioverter-defibrillators (ICDs) and patients with cardiac resynchronization therapy-defibrillators (CRTDs) were included in the same cohort (1). The indications of these devices are different and the baseline characteristics might be heterogeneous. CRT-D would have advantages over ICD in facilitating reverse remodeling and preventing ventricular arrhythmias. Patients who received a CRT-D should be excluded. The clinical implications of their findings are unclear. What can we do according to their findings? Patients with lower galectin-3 levels might have a lower risk of developing ventricular arrhythmias (1). Nevertheless, they satisfy the conventional indication for ICD implantation and we will eventually implant an ICD in these patients irrespective of their galectin-3 levels. Of note, some patients had a history of ventricular arrhythmias. For patients with elevated galectin-3 levels, could the authors recommend any interventions to prevent future events? At least those with a history of ventricular arrhythmias should be excluded. The third concern is a statistical one. The observational periods varied in each patient (1). It might not be appropriate to perform a receiver operating characteristic analysis in such a situation. The observational period should be unified among all participants. Or a time-dependent receiver operating characteristic analysis would be more ideal.