Growth differentiation factor 15 as mortality predictor in heart failure patients with non-reduced ejection fraction
Autor: | Álvaro García-Osuna, Eulalia Roig Minguell, Sonia Mirabet‐Perez, Andreu Ferrero-Gregori, Maria Jose Pirla‐Buxo, Jordi Ordóñez-Llanos, Juan Cinca‐Cuscullola, Ana Belen Mendez Fernandez |
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Rok vydání: | 2019 |
Předmět: |
Male
medicine.medical_specialty GDF‐15 Growth Differentiation Factor 15 medicine.drug_class 030204 cardiovascular system & hematology HFmrEF 03 medical and health sciences 0302 clinical medicine Internal medicine Natriuretic peptide Medicine Diseases of the circulatory (Cardiovascular) system Humans In patient 030212 general & internal medicine Survival analysis Aged Aged 80 and over Heart Failure Ejection fraction business.industry Stroke Volume Middle Aged Serum samples medicine.disease HFpEF Prognosis Chronic heart failure GDF-15 Heart failure RC666-701 Cardiology Biomarker (medicine) Female GDF15 Cardiology and Cardiovascular Medicine business Biomarkers |
Zdroj: | ESC Heart Failure r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname Dipòsit Digital de Documents de la UAB Universitat Autònoma de Barcelona ESC Heart Failure, Vol 7, Iss 5, Pp 2223-2229 (2020) r-IIB SANT PAU: Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau Institut dInvestigació Biomèdica Sant Pau (IIB Sant Pau) |
ISSN: | 2055-5822 |
Popis: | Altres ajuts: This study was supported by Fundació d'Investigació Sant Pau (G-60136934). The prognostic value of biomarkers in patients with heart failure (HF) and mid-range (HFmrEF) or preserved ejection fraction (HFpEF) has not been widely addressed. The aim of this study was to assess whether the prognostic value of growth differentiation factor 15 (GDF-15) is superior to that of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with HFmrEF or HFpEF. Heart failure patients with either HFpEF or HFmrEF were included in the study. During their first visit to the HF unit, serum samples were obtained and stored for later assessment of GDF-15 and NT-proBNP concentrations. Patients were followed up by the HF unit. The main endpoint was all-cause mortality. A total of 311 patients, 90 (29%) HFmrEF and 221 (71%) HFpEF, were included. Mean age was 72 ± 13 years, and 136 (44%) were women. No differences were found in GDF-15 or NT-proBNP concentrations between both HF groups. During a median follow-up of 15 months (Q1-Q3: 9-30 months), 98 patients (32%) died, most (71%) of cardiovascular causes. Patients who died had higher median concentrations of GDF-15 (4085 vs. 2270 ng/L, P < 0.0001) and NT-proBNP (1984 vs. 1095 ng/L, P < 0.0001). A Cox multivariable model identified New York Heart Association Functional Class III (P = 0.04), systolic blood pressure (P = 0.01), left atrial diameter (P = 0.03), age >65 years (P < 0.0001), and GDF-15 concentrations (P = 0.01) but not NT-proBNP as independent predictors of all-cause mortality. The area under the curve was 0.797 for the basic model including NT-proBNP, and the area under the curve comparing the overall model was 0.819, P = 0.016 (DeLong's test). Integrated discrimination improvement index after the inclusion of GDF-15 in the model with the mortality risk factors was 0.033; that is, the ability to predict death increased by 3.3% (P = 0.004). Net reclassification improvement was 0.548 (P < 0.001); that is, the capacity to improve the classification of the event (mortality) was 54.8%. GDF-15 concentrations were divided in tertiles (4330 ng/L), and survival curves were evaluated using the Kaplan-Meier technique. Patients in the highest tertile had the poorest 5 year survival, at 16%, whereas the lowest tertile had the best survival, of 78% (P < 0.001). Growth differentiation factor 15 was superior to NT-proBNP for assessing prognosis in patients with HFpEF and HFmrEF. GDF-15 emerges as a strong, independent biomarker for identifying HFmrEF and HFpEF patients with worse prognosis. |
Databáze: | OpenAIRE |
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