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J Geriatr Cardiol. 2018 Oct;15(10):618-627. doi: 10.11909/j.issn.1671-5411.2018.10.002.

Repeated measurement of growth-differentiation factor-15 in Chinese Han patients with post-myocardial infarction chronic heart failure.

Liu JX1,2,3, Li YP4,5, Liu BH1,2,3, Zhao XJ1,2, Zhang ZY1,2,3, Wang JD3, Jia Q1,2, Liu CL1,2, Gao XJ1,2,3, Xu ZG1,2,3, Zhang HW3, Song LN6, Sun ZJ3, He KL1,2.

Author information

1
Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Chinese PLA General Hospital, Beijing, China.
2
Transformation Medicine Centre, Chinese PLA General Hospital, Beijing, China.
3
Department of Cardiovascular, Chinese PLA General Hospital, Beijing, China.
4
Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China.
5
Outpatient Department of North China Military Materials Procurement Bureau, Tianjin, China.
6
Queen Mary College of Nanchang University, Nanchang, China.

Abstract

Background:

Growth-differentiation factor-15 (GDF-15) is a promising prognostic biomarker in patients with chronic heart failure (CHF). Comparatively little is known about the value of repeated measurement of GDF-15 with CHF in Chinese Han population. This study sought to identify the clinical value of repeated measurement of GDF-15 in Chinese Han patients with post-myocardial infarction CHF.

Methods:

In total, 232 consecutive Chinese Han patients with post-myocardial infarction CHF were enrolled prospectively from January 2014 to June 2016.The plasma concentration of GDF-15 was determined on admission and over 12 months. Patients were followed up for all-cause death and a composite outcome of major adverse cardiac events (MACE) included all-cause death, myocardial infarction and first heart failure (HF) re-hospitalization. Association with other clinical variables and adverse outcomes of repeated measurement of GDF-15 was explored.

Results:

The median baseline GDF-15 level was 2025 ng/L. Baseline GDF-15 was moderately associated with baseline N-terminal pro-B type natriuretic peptide (NT-proBNP) (coefficient 0.561, P < 0.001). During a median follow-up of 20 months, there were 53 deaths and 100MACE. GDF-15 remained an independent predictor of all-cause death (adjusted hazard ratio 1.826 per 1 Ln U, 95% CI: 1.037-8.360; P = 0.037) and MACE (adjusted hazard ratio 2.243 per 1 Ln U, 95% CI: 1.181-1.775; P < 0.001) adjusted for established risk factors. Repeated measurement of GDF-15 was performed in 173 survivals over 12months. Increase of GDF-15 over 12 months was associated with dilatation of left ventricle and acted as an independent predictor of subsequent all-cause death (adjusted HR = 3.164, 95% CI: 1.245-0.041; P = 0.015). In the joint model, GDF-15 was also shown to be a risk factor for all-cause death (HR = 2.749, 95% CI: 1.667-3.831; P < 0.001) and MACE (HR = 2.434, 95% CI: 1.425-3.443; P < 0.001).

Conclusions:

Repeated measurements of GDF-15 have promising prognostic value of the risk of all-cause death in Chinese Han patients with CHF post-myocardial infarction. GDF-15 may influence the post-myocardial infarction CHF through the path physiological pathway of myocardial remodeling.

KEYWORDS:

Chronic heart failure; Growth-differentiation factor-15; Left ventricular remodeling; Myocardial infarction; Prognosis

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