Growth-Differentiation Factor-15 and Major Cardiac Events

• Published in: The American journal of the medical sciences 2014-04, Vol.347 (4), p.305-311
• Main Authors: Lin, Jeng-Feng, MD, Wu, Semon, PhD, Hsu, Shun-Yi, MD, Yeh, Kuan-Hung, MD, Chou, Hsin-Hua, MD, Cheng, Shih-Tsung, MD, Wu, Tien-Yu, MD, Hsu, Wen-Tze, Yang, Chun-Chun, MS, Ko, Yu-Lin, MD, PhD
• Format: Article
• Language: English
• Subjects: Acute myocardial infarction; Aged; Biomarkers - blood; Female; GDF-15; Growth Differentiation Factor 15 - blood; Heart Failure - blood; Heart Failure - etiology; Humans; Internal Medicine; Kaplan-Meier Estimate; Left ventricular remodeling; Male; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - complications; Myocardial Infarction - mortality; N-terminal pro-B-type natriuretic peptide; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Prognosis; Prospective Studies; Stroke Volume; Ventricular Remodeling
• ISSN: 0002-9629; 1538-2990
• DOI: 10.1097/MAJ.0b013e318291cd4e

Background Growth-differentiation factor (GDF)-15 is a strong predictor of cardiovascular events in patients with ST-elevation myocardial infarction (STEMI). However, the effects of GDF-15 on left ventricular (Lv) remodeling have not been clearly elucidated. The aim of this study is to investigate whether GDF-15 will be of benefit in predicting LV remodeling, heart failure and death in patients with STEMI. Methods The authors enrolled 216 patients with STEMI who received measurement of GDF-15 level on day 2 of hospitalization. Echocardiographic studies were performed at baseline and were repeated 6 months later. Clinical events, including all-cause death and readmission for heart failure, were followed up for a maximum of 3 years. Results Patients with GDF-15 levels above the median had lower LV ejection fraction at baseline (43.9% versus 48.0%, P = 0.041) and at 6 months (51.5% versus 56.9%, P = 0.025). In univariable regression model, log-transformed GDF-15 level was not a predictor of increase in LV end-diastolic volume index at 6 months ( P = 0.767). Kaplan-Meier survival curves showed that the combination of high GDF-15 and high N -terminal pro-B-type natriuretic peptide was a strong predictor of death and heart failure ( P < 0.001). In multivariable Cox regression model, the independent predictors of death and heart failure were age, GDF-15 level and diabetes mellitus. Conclusions High GDF-15 level is a strong predictor of death and heart failure in patients with STEMI. Although patients with higher GDF-15 levels tend to have lower LV ejection fraction, they have similar degree of the increase in LV end-diastolic volume index at 6 months.