Growth Differentiation Factor-15 Is a Useful Prognostic Marker in Patients With Heart Failure With Preserved Ejection Fraction

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• 作者：Yasuhiro Izumiya ; MD ; PhD ; ^{izumiya@kumamoto-u.ac.jp" class="auth_mail} ; Shinsuke Hanatani ; MD ; Yuichi Kimura ; MD ; Seiji Takashio ; MD ; PhD ; Eiichiro Yamamoto ; MD ; PhD ; Hiroaki Kusaka ; MD ; Takanori Tokitsu ; MD ; Taku Rokutanda ; MD ; Satoshi Araki ; MD ; PhD ; Kenichi Tsujita ; MD ; PhD ; Tomoko Tanaka ; MD ; PhD ; Megumi Yamamuro ; MD ; PhD ; Sunao Kojima ; MD ; PhD ; Shinji Tayama ; MD ; PhD ; Koichi Kaikita ; MD ; PhD ; Seiji Hokimoto ; MD ; PhD ; Hisao Ogawa ; MD ; PhD
• 刊名：Canadian Journal of Cardiology
• 出版年：March, 2014
• 年：2014
• 卷：30
• 期：3
• 页码：338-344
• 全文大小：552 K

文摘

Background

Circulating growth differentiation factor 15 (GDF-15) levels correlate with heart mass and fibrosis; however, little is known about its value in predicting the prognosis of patients with heart failure with preserved ejection fraction (HFpEF).

Methods

We measured serum GDF-15 levels in 149 consecutive patients with left ventricular diastolic dysfunction (LVDD) and normal LV ejection fraction (>50%) and followed them for cardiovascular events. LVDD was defined according to the European Society of Cardiology guidelines.

Results

The New York Heart Association functional class and circulating B-type natriuretic peptide (BNP) levels were significantly higher in the high-GDF-15 group (n聽= 75; greater than or equal to the median value [3694 pg/mL]) than in the low-GDF-15 group (n聽= 74). Patients were divided into HFpEF and LVDD groups according to the presence or absence of HF. Serum GDF-15 levels were significantly higher in the HFpEF group (n聽= 73) than in the LVDD group (n聽= 76) (median, 4215 [interquartile range, 3382-5287] vs 3091 [interquartile range, 2487-4217 pg/mL]; P < 0.0001). Kaplan-Meier curve analysis showed a significantly higher probability of cardiovascular events in the high-GDF-15 group than in the low-GDF-15 group for data of all patients (log-rank test P聽= 0.006) and data of patients in the HFpEF group only (P聽= 0.014). Multivariate Cox hazard analysis identified age (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.87-0.98; P聽= 0.008), atrial fibrillation (HR, 7.95; 95% CI, 1.98-31.85, P聽= 0.003), lnBNP (HR, 3.37; 95% CI, 1.73-6.55; P < 0.0001), and GDF-15 (ln[GDF-15]) (HR, 4.74; 95% CI, 1.26-17.88, P聽= 0.022) as independent predictors of primary end points.

Conclusions

GDF-15 is a potentially useful prognostic biomarker in patients with HFpEF.