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Growth/differentiation factor-15 (GDF-15) as a predictor of serious arrhythmic events in patients with nonischemic dilated cardiomyopathy
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  • Bruna Miers May,
  • Adriano Kochi,
  • Ana Paula Magalhães,
  • Fernando Scolari,
  • André Zimerman,
  • Michael Andrades,
  • Leandro Zimerman,
  • Luis Eduardo Rohde,
  • Mauricio Pimentel
Bruna Miers May
Hospital de Clinicas de Porto Alegre

Corresponding Author:[email protected]

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Adriano Kochi
Hospital São Lucas da PUC-RS
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Ana Paula Magalhães
Hospital de Clinicas de Porto Alegre
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Fernando Scolari
Hospital de Clinicas de Porto Alegre
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André Zimerman
Hospital de Clinicas de Porto Alegre
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Michael Andrades
Hospital de Clinicas de Porto Alegre
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Leandro Zimerman
Hospital de Clinicas de Porto Alegre
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Luis Eduardo Rohde
Hospital de Clinicas de Porto Alegre
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Mauricio Pimentel
Hospital de Clinicas de Porto Alegre
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Abstract

Introduction: Cardiac biomarkers have been proposed as a new tool to improve risk stratification of serious arrhythmic events in patients with heart failure (HF) beyond estimates of left ventricular ejection fraction. Growth differentiation factor (GDF)-15, a stress-induced cytokine, has been found to correlate with markers of myocardial fibrosis and adverse clinical outcomes, but its role as a predictor of arrhythmic events in patients with nonischemic HF is uncertain. Methods and Results: A prospective observational study was conducted in 148 nonischemic patients with HF who underwent comprehensive clinical and laboratory evaluation, including measurement of serum GDF-15. The study endpoints were serious arrhythmic events (which included appropriate implantable cardioverter-defibrillator therapy and sudden cardiac death) and all-cause mortality. Mean age of the cohort was 54.8±12.7 years, and mean left ventricular ejection fraction (LVEF) was 27.4±7.5. During a mean follow-up time of 42 months, arrhythmic events occurred in 28 patients (19%), and 40 patients (27%) died. An increase in serum GDF-15 (log-transformed) correlated linearly with a higher risk of serious arrhythmic events (HR 1.14, 95% CI 1.01-1.28, p=0.03) even after adjustment for other potential clinical predictors (HR 1.16, 95% CI 1.02-1.32, p=0.02). GDF-15 was also strongly and independently associated with all-cause mortality (HR 1.17, 1.05-1.31, p=0.004). Conclusion: In this cohort of nonischemic HF patients on optimized medical treatment, serum GDF-15 levels were independently associated with major arrhythmic events and overall mortality. This biomarker may add prognostic information beyond LVEF to better stratify the risk of sudden death in this particular population.