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

Ji-Xuan Liu; Yan-Ping Li; Bo-Han Liu; Xiao-Jing Zhao; Ze-Yu Zhang; Jin-Da Wang; Qian Jia; Chun-Lei Liu; Xiao-Jian Gao; Zhen-Guo Xu; Hua-Wei Zhang; Lin-Nan Song; Zhi-Jun Sun; Kun-Lun He

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

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

Authors

Ji-Xuan Liu^{1

2

3}, Yan-Ping Li^{4

5}, Bo-Han Liu^{1

2

3}, Xiao-Jing Zhao^{1

2}, Ze-Yu Zhang^{1

2

3}, Jin-Da Wang³, Qian Jia^{1

2}, Chun-Lei Liu^{1

2}, Xiao-Jian Gao^{1

2

3}, Zhen-Guo Xu^{1

2

3}, Hua-Wei Zhang³, Lin-Nan Song⁶, Zhi-Jun Sun³, Kun-Lun He^{1

2}

Affiliations

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.

PMID: 30416510
PMCID: PMC6221845
DOI: 10.11909/j.issn.1671-5411.2018.10.002

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.