Growth/differentiation factor-15 (GDF-15) as a predictor of serious
arrhythmic events in patients with nonischemic dilated cardiomyopathy
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.