The Novel Biomarker Growth Differentiation Factor-15 in Patients with Chronic Heart Failure at a Heart Failure Clinic in the Asia-Pacific Region: A Prospective Observational Study

Abstract

Background: Growth differentiation factor-15 (GDF-15) is an emerging prognostic biomarker in heart failure (HF). However, there are limited data on its role in HF patients in southeast Asia. This prospective observational study investigated the association between GDF-15 and various clinical parameters, and its role in predicting all-cause mortality. Methods: 160 patients with chronic HF and reduced left ventricular ejection fraction (LVEF) enrolled between October 2020 and April 2021. At study entry, baseline GDF-15 and N-terminal pro B-type natriuretic peptide (NT-proBNP) were evaluated. Patients were followed up per clinical routine. Results: The median GDF-15 was 1,715 ng/l. Patients were divided into two groups: GDF-15 <2,000 or ≥2,000 ng/l. This cut-off has been shown to represent prognostic threshold in previous studies. The GDF-15 ≥2,000 group was older, had more severe HF and higher comorbidity burden, and lower use of renin–angiotensin–aldosterone system inhibitors (RAASi). GDF-15 was positively correlated with a history of MI, diabetes, chronic kidney disease and use of loop diuretics, but negatively correlated with RAAsi use. GDF-15 ≥2,000 was not associated with all-cause mortality at 60 weeks. The pooled stratum of GDF-15 ≥2,000/NT-proBNP ≥1,000 pg/ml had significantly higher mortality than GDF-15 <2,000/NT-proBNP <1,000 pg/ml. NT-proBNP and the Meta-Analysis Global Group In Chronic risk score but not GDF-15, were independently predictive of all-cause mortality. Conclusion: In our cohort of chronic HF patients with reduced LVEF who were relatively younger than the cohorts studied in previous GDF-15 in HF trials, well-managed and largely asymptomatic, GDF-15 did not independently predict all-cause mortality. The prognostic cut-off of GDF-15 ≥2,000 ng/l was not significantly associated with higher all-cause mortality at 60 weeks.