Growth differentiation factor 15 as an integrative biomarker of heart failure in patients with acute myocardial infarction

Abstract

Growth differentiation factor 15 (GDF15), a stress-responsive cytokine member of the transforming growth factor-β family, is an emerging biomarker in cardiovascular (CV) diseases. GDF15 is weakly expressed in normal condition but increased in pathological situations such as inflammation, oxidative stress, and left-ventricular remodeling. Recent data suggest GDF15 as a marker in heart failure (HF). We aimed to measure the levels of GDF15 in patients admitted for an acute myocardial infarction (AMI) and HF. In our prospective study, we included all consecutive patients admitted from June 2016 to October 2017 with type 1 AMI from the ‘obseRvatoire des Infarctus de Côte d’Or’ (RICO) survey. Chronic congestive HF patients were excluded. Admission and hospital HF were diagnosed by killip class > 1. Serum levels of GDF15 were measured using a commercially available ELISA kit. Among the 219 AMI patients, median-age was at 69(58–80) y, 29% were women, 25% had diabetes and 63% were hypertensive. GDF15 levels (median = 1254 (819–2140) ng/L) were strongly correlated with age ( r = 0.558, P < 0.001), and elevated with most CV risk factors (i.e. hypertension, diabetes, hypercholesterolemia), prior CAD, chronic kidney disease ( P < 0.001 for all) and in patients with CRP > 3 mg/L ( P < 0.001). When compared with patients without HF, patients who developed HF on admission (22%) or in-hospital (6%), GDF15 was markedly higher ( Fig. 1 ). GDF15 levels were negatively correlated with LVEF ( r = -0.142, P < 0.05). Moreover, Receiving Operating Curve analysis showed that GDF15 was associated with HF (AUC = 0.69 (0.61–0.77), P < 0.001). These preliminary results suggest that GDF15 could be an integrative biomarker of HF in patient with AMI. Further studies are needed to elucidate the underlying mechanisms linking the cytokine with the development of HF and to investigate its use for patient monitoring in AMI.