Letter to the Editor regarding the 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' by Zivlas et al. (2017).

Cys-C has been extensively studied in the context of HF. It is largely accepted nowadays that Cys-C is a fine surrogate marker of glomerular filtration rate (GFR),2 and not involved in heart remodelling3 nor in the pathogenesis of cardiovascular diseases.4 Similarly, the initial hope with Gal-3, has been dismantled by studies showing that it is, again, merely a marker of GFR that does not add prognostic information after correcting for renal function,5 nor is it involved in the pathogenesis of fibrotic changes at a myocardial level in HF from hypertensive origin.6