Relationship between the serum GDF-15 concentration and muscle function in female patients receiving aortic valve replacement (TAVR, SAVR): Comparison with healthy elderly female subjects

Taira Fukuda; Toshiaki Nakajima; Hiroko Yazawa; Suguru Hirose; Jun Yokomachi; Takashi Kato; Riichi Nishikawa; Nobuo Koshiji; Michiaki Tokura; Takahisa Nasuno; Setsu Nishino; Syotaro Obi; Ikuko Shibasaki; Tomoaki Kanaya; Fumitaka Nakamura; Hirotsugu Fukuda; Shichiro Abe; Masashi Sakuma; Shigeru Toyoda

doi:10.1016/j.ijcha.2022.101032

Relationship between the serum GDF-15 concentration and muscle function in female patients receiving aortic valve replacement (TAVR, SAVR): Comparison with healthy elderly female subjects

Int J Cardiol Heart Vasc. 2022 Apr 18:40:101032. doi: 10.1016/j.ijcha.2022.101032. eCollection 2022 Jun.

Authors

Taira Fukuda¹, Toshiaki Nakajima², Hiroko Yazawa², Suguru Hirose², Jun Yokomachi², Takashi Kato³, Riichi Nishikawa², Nobuo Koshiji², Michiaki Tokura², Takahisa Nasuno², Setsu Nishino², Syotaro Obi², Ikuko Shibasaki³, Tomoaki Kanaya², Fumitaka Nakamura⁴, Hirotsugu Fukuda³, Shichiro Abe², Masashi Sakuma², Shigeru Toyoda²

Affiliations

¹ Department of Liberal Arts and Human Development, Kanagawa University of Human Services, Yokosuka, Kanagawa 238-8522, Japan.
² Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan.
³ Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan.
⁴ Third Department of Internal Medicine, Teikyo University, Chiba Medical Center, Ichihara, Chiba 299-0111, Japan.

Abstract

Purpose: Sarcopenia is closely associated with postoperative prognosis in patients undergoing cardiovascular surgery. Growth differentiation factor (GDF)-15 is involved in the pathogenesis of cardiovascular disease. We examined the relationship between the serum GDF-15 concentration and muscle function in patients receiving aortic valve replacement and healthy elderly subjects.

Methods: Forty-three female patients undergoing aortic valve surgery (79.9 ± 6.4 years; transcatheter aortic valve replacement [TAVR] n = 19, conventional surgical aortic valve replacement [SAVR] n = 24) and 64 healthy elderly female subjects (75.9 ± 6.1 years) were included. Walking speed, grip strength, and skeletal muscle mass index (SMI) by a multifrequency bioelectrical impedance analyzer were measured to determine the presence of sarcopenia. Preoperative serum GDF-15 concentration was measured by enzyme-linked immunosorbent assay.

Results: The GDF-15 level was higher in patients receiving aortic valve replacement than in healthy elderly subjects (aortic valve replacement: 1624 ± 1186 pg/mL vs. healthy: 955 ± 368 pg/mL, p < 0.001). Multivariate linear regression analysis showed that the serum GDF-15 level determined grip strength independently of the high-sensitivity C-reactive protein level and eGFR, even after adjusting for age (β = -0.318, p = 0.025). Sarcopenia was found in 12.5% of healthy elderly subjects, 83.3% of patients with TAVR, and 64.3% of patients with SAVR. The GDF-15 concentration that defined sarcopenia was 1109 pg/mL in subjects including patients receiving aortic valve replacement.

Conclusions: The preoperative serum GDF-15 concentration, which was higher in female patients receiving aortic valve replacement than in healthy elderly subjects, may be a serum marker of sarcopenia.

Keywords: ANOVA, analysis of variance; AS, aortic stenosis; AWGS, Asian Working Group for Sarcopenia; Aortic valve replacement; BNP, brain natriuretic peptide; CFS, Clinical Frailty Scale; CHF, chronic heart failure; ELISA, enzyme-linked immunosorbent assay; GDF, growth differentiation factor; GH, growth hormone; Growth differentiation factor −15; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; PAH, pulmonary arterial hypertension; ROC, receiver-operating characteristics; SAVR, conventional surgical aortic valve replacement; SMI, skeletal muscle mass index; Sarcopenia; TAK1, TGFβ-activated kinase 1; TAVR, transcatheter aortic valve replacement; TGF, transforming growth factor; VO2, oxygen uptake; eGFR, estimated glomerular filtration rate; hsCRP, high-sensitive C-reactive protein.